Abstract:
AIM:To define the long-term outcome of patients presenting with acute coronary syndrome [ST-segment elevation myocardial infarction (STEMI), and non-STEMI and unstable angina acute coronary syndrome (ACS) without biomarker elevation] and to test the hypothesis that the GRACE (Global Registry of Acute Coronary Events) risk score predicts mortality and death/MI at 5 years. METHODS AND RESULTS:In the GRACE long-term study, UK and Belgian centres prospectively recruited and followed ACS patients for a median of 5 years (1797 days). Primary outcome events: deaths, cardiovascular deaths (CVDs) and MIs. Secondary events: stroke and re-hospitalization for ACS. There were 736 deaths, 19.8% (482 CVDs, 13%) and 347 (9.3%) MIs (>24 h), 261 strokes (7.7%), and 452 (17%) subsequent revascularizations. Rehospitalization was common: average 1.6 per patient; 31.2% had >1 admission, 9.2% had 5+ admissions. These events were despite high rates of guideline indicated therapies. The GRACE score was highly predictive of all-cause death, CVD, and CVD/MI at 5 years (death: χ(2) likelihood ratio 632; Wald 709.9, P< 0.0001, C-statistic 0.77; for CVD C-statistic 0.75, P < 0.0001; CVD/MI C-statistic 0.70, P < 0.0001). Compared with the low-risk GRACE stratum (ESC Guideline criteria), those with intermediate [hazard ratio (HR) 2.14, 95% CI 1.63, 2.81] and those with high-risk (HR 6.36, 95% CI 4.95, 8.16) had two- and six-fold higher risk of later death (Cox proportional hazard). A landmark analysis after 6 months confirmed that the GRACE score predicted long-term death (χ(2) likelihood ratio 265.4; Wald 289.5, P < 0.0001). Although in-hospital rates of death and MI are higher following STEMI, the cumulative rates of death (and CVD) were not different, by class of ACS, over the duration of follow-up (Wilcoxon = 1.5597, df = 1, P = 0.21). At 5 years after STEMI 269/1403 (19%) died; after non-STEMI 262/1170 (22%) after unstable angina (UA) 149/850 (17%). Two-thirds (68%) of STEMI deaths occurred after initial hospital discharge, but this was 86% for non-STEMI and 97% for UA. CONCLUSION:The GRACE risk score predicts early and 5 year death and CVD/MI. Five year morbidity and mortality are as high in patients following non-ST MI and UA as seen following STEMI. Their morbidity burden is high (MI, stroke, readmissions) and the substantial late mortality in non-STE ACS is under-recognized. The findings highlight the importance of pursuing novel approaches to diminish long-term risk.
journal_name
Eur Heart Jjournal_title
European heart journalauthors
Fox KA,Carruthers KF,Dunbar DR,Graham C,Manning JR,De Raedt H,Buysschaert I,Lambrechts D,Van de Werf Fdoi
10.1093/eurheartj/ehq326subject
Has Abstractpub_date
2010-11-01 00:00:00pages
2755-64issue
22eissn
0195-668Xissn
1522-9645pii
ehq326journal_volume
31pub_type
杂志文章,多中心研究abstract::To assess the clinical significance of monitoring during physical training in post-myocardial infarction (MI) patients with asymptomatic exercise-induced ischaemia, we studied 232 patients who were survivors of first recent acute MI and consecutively admitted to the same CCU, who underwent an exercise test (ET) and co...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/9.suppl_n.176
更新日期:1988-12-01 00:00:00
abstract::Antiarrhythmic agents may depress cardiac contractility and worsen heart failure. Flecainide is an effective antiarrhythmic drug, but when administered orally in patients with left ventricular (LV) dysfunction, its effect on LV function is unknown. To assess the effects of flecainide on cardiac function, LV ejection f...
journal_title:European heart journal
pub_type: 临床试验,杂志文章
doi:10.1093/eurheartj/8.7.754
更新日期:1987-07-01 00:00:00
abstract::Although several randomized trials have been performed to compare the outcomes of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG) in patients with multivessel disease, there is little data available on angiographic follow-up results. The present substudy of the German an...
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:10.1093/oxfordjournals.eurheartj.a015036
更新日期:1996-08-01 00:00:00
abstract:AIMS:To determine the sequence of critical cardiovascular events in the progression of heart failure, and whether aetiology or high-dose vs low-dose lisinopril affected these pathways. METHODS AND RESULTS:This was a post-hoc investigation of the ATLAS database, which comprised 3164 patients with chronic heart failure,...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.2000.2570
更新日期:2001-09-01 00:00:00
abstract:AIMS:The aim of this study was to assess whether perioperative N-acetylcysteine (NAC), an antioxidant, prevents acute renal injury (ARI) after cardiac surgery. METHODS AND RESULTS:We performed a systematic review of randomized controlled trials (RCTs) of NAC in adult cardiac surgery patients. The RCTs were identified ...
journal_title:European heart journal
pub_type: 杂志文章,meta分析,评审
doi:10.1093/eurheartj/ehp053
更新日期:2009-08-01 00:00:00
abstract:AIMS:The aim of this study was to assess the risk of intra-aortic balloon counterpulsation and to identify clinical and procedural variables that would predict complications. METHODS AND RESULTS:We analysed 381 consecutive patients who were treated between 1977 and 1995 at our catheterization laboratory and/or medical...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.1997.0802
更新日期:1998-03-01 00:00:00
abstract:AIMS:We sought to define the mechanisms and correlates of leptin's vascular actions in humans with coronary artery disease. METHODS AND RESULTS:In 131 patients (age 65.7+/-0.7 years mean+/-SEM), ex vivo vascular reactivity to leptin (10(-13)-10(-7) M) was assessed in saphenous vein (SV) rings. Leptin led to SV relaxat...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehi831
更新日期:2006-10-01 00:00:00
abstract::We have evaluated overall and cardiac sympathetic activity in 47 patients undergoing coronary angiography, 27 with stable angina of at least 3 months duration, and 20 with unstable ischaemic symptoms within this period. Cardiac and overall sympathetic activity were assessed using radiotracer noradrenaline kinetic tech...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/14.6.751
更新日期:1993-06-01 00:00:00
abstract::Impedance cardiography may be a simple way of assessing left ventricular performance during exercise. Measurements were therefore made during exercise testing in 102 consecutive male patients with suspected coronary disease prior to cardiac catheterization. These were subsequently divided into four groups: group A, no...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/14.2.150
更新日期:1993-02-01 00:00:00
abstract:Aims:Inhalation of nitric oxide (iNO) during myocardial ischaemia and after reperfusion confers cardioprotection in preclinical studies via enhanced cyclic guanosine monophosphate (cGMP) signalling. We tested whether iNO reduces reperfusion injury in patients with ST-elevation myocardial infarction (STEMI; NCT01398384)...
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/ehy232
更新日期:2018-08-01 00:00:00
abstract:AIMS:Patients with diabetes are at excessive risk of mortality and cardiovascular morbidity. Previous studies suggest that aspirin may be less effective in diabetic patients. In this multi-centre, randomized, double blind trial picotamide, a dual inhibitor of thromboxane A2 synthase and receptor, was compared with aspi...
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:10.1016/j.ehj.2004.07.013
更新日期:2004-10-01 00:00:00
abstract::Recombinant tissue-type plasminogen activator (rt-PA) is presently used for the treatment of different clinical entities, mostly myocardial infarction. Its use for treatment of thrombotic dysfunction of prosthetic cardiac valves is more recent and has been only rarely reported. A 33-year-old woman with a St Jude Medic...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a059435
更新日期:1989-12-01 00:00:00
abstract::When selecting coronary stenoses for interventional treatment, assessment of reversible ischaemia is paramount from a symptomatic as well as prognostic point of view. Fractional flow reserve (FFR) is now considered the gold standard for invasive assessment of ischaemia. By measuring FFR in the catheterization laborato...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/ehs436
更新日期:2013-05-01 00:00:00
abstract::The cytokine hypothesis presently suggests that an excessive production of pro-inflammatory cytokines, such as tumour necrosis factor alpha (TNF) and interleukin 6 (IL6), contributes to the pathogenesis of heart failure. The concept, successfully proved in genetically modified animal models, failed to translate to hum...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/ehq484
更新日期:2011-03-01 00:00:00
abstract:AIMS:Patients with acute coronary syndrome (ACS) in the Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study had diminished cardiovascular events after 16 weeks of treatment of atorvastatin 80 mg daily. We determined whether plasma lipoproteins at baseline and then at 6 weeks after randomi...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/eurheartj/ehi186
更新日期:2005-05-01 00:00:00
abstract:AIM:Previous studies have reported lifestyle and risk factor deterioration following completion of a cardiac rehabilitation program (CRP). We report the results of a one-year Extensive Lifestyle Management Intervention (ELMI) aimed at preventing these adverse changes. METHODS AND RESULTS:A total of 302 men and women w...
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:10.1016/j.ehj.2003.08.015
更新日期:2003-11-01 00:00:00
abstract::Treatment of 8 hypertensive elderly subjects with atenolol or with labetalol did not affect exercise performance, except after the development of circulatory congestion in 1 patient. Treatment with beta blockers did not alter the response to an exercise training programme in 15 elderly patients with ischaemic heart di...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/5.suppl_e.117
更新日期:1984-11-01 00:00:00
abstract::Over two decades after the introduction of cardiac resynchronization therapy (CRT) into clinical practice, ∼30% of candidates continue to fail to respond to this highly effective treatment of drug-refractory heart failure (HF). Since the causes of this non-response (NR) are multifactorial, it will require multidiscipl...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/ehw270
更新日期:2017-05-14 00:00:00
abstract:AIMS:We addressed a potential mechanism of myocardial dysfunction following coronary microembolization at the level of myofibrillar proteins. METHODS AND RESULTS:Anaesthetized pigs underwent intracoronary infusion of microspheres. After 6 h, the microembolized areas (MEA) had decreased systolic wall thickening to 38 +...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehi751
更新日期:2006-04-01 00:00:00
abstract::The purpose of this study was to evaluate the characteristics of mitral annular motion during diastole in 28 normal subjects, 40 patients with prior myocardial infarction (MI), and 23 patients with coronary artery disease but without prior MI. Mitral annular motion during diastole was obtained from the apex by M-mode ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a061029
更新日期:1995-07-01 00:00:00
abstract:AIM:Few epidemiological data are available describing the sudden death of persons in their prime. This study aims to elucidate when and how sudden death occurs among employees. METHODS:A total of 196775 employees from 10 workplaces in Central Japan were surveyed for non-traumatic sudden death during 1989-1995. Demogra...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.1998.1189
更新日期:1999-03-01 00:00:00
abstract::Between January 1983 and December 1990, 20 patients aged 80 years or older underwent valvular surgery. The patients' ages varied from 80 to 87 years (mean, 82 +/- 1.5 years). The indication for operation was aortic stenosis in 19 patients, and mitral insufficiency after previous mitral valve replacement with a biopros...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060205
更新日期:1992-04-01 00:00:00
abstract::Simultaneous two-channel Holter monitoring, with a direct recording system, and maximal exercise testing with a 12-lead precordial electrocardiographic mapping system were performed in 50 patients with chest pain (41 with documented coronary artery disease, 9 without). The exploring Holter leads were placed to corresp...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a062518
更新日期:1988-04-01 00:00:00
abstract:AIMS:Patients with pulmonary hypertension (PHT) are often excluded from surgical therapies for tricuspid regurgitation (TR). Transcatheter tricuspid valve repair (TTVR) with the MitraClip™ technique is a novel treatment option for these patients. We aimed to assess the role of PHT in severe TR and its implications for ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehaa138
更新日期:2020-08-01 00:00:00
abstract::Clinicians have long suspected that hypertrophied hearts have an inadequate coronary circulation. This clinical suspicion resulted from the observation that a large proportion of patients with left ventricular hypertrophy who have normal coronary arteriograms complain of angina and have ischaemia-like ST segment depre...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:
更新日期:1993-11-01 00:00:00
abstract::Hereditary factors may have a part to play in the development of bicuspid aortic valve. This report concerns a pair of identical twins, probably monozygotic, who required aortic valve replacement as a result of aortic stenosis occurring in bicuspid aortic valves. This supports the contention that there may be a geneti...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a062276
更新日期:1987-03-01 00:00:00
abstract::Recently published epidemiological and genetic studies strongly suggest a causal relationship of elevated concentrations of lipoprotein (a) [Lp(a)] with cardiovascular disease (CVD), independent of low-density lipoproteins (LDLs), reduced high density lipoproteins (HDL), and other traditional CVD risk factors. The ath...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/eht053
更新日期:2013-11-01 00:00:00
abstract::Several targets for heart failure therapy may be met through different mechanisms which are not necessarily associated. In the Australia/New Zealand Heart Failure Research Collaborative Group Study, patients with chronic stable heart failure of ischaemic aetiology on treatment including ACE inhibitors were randomized ...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:
更新日期:1998-02-01 00:00:00
abstract:AIMS:Although a recent expert consensus statement has recommended periprocedural uninterrupted (UI) non-vitamin K antagonist oral anticoagulants (NOACs) during catheter ablation of atrial fibrillation (AF) as a Class I indication, there have been no clear randomized trials. We investigated the safety and efficacy of UI...
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/ehy870
更新日期:2019-05-14 00:00:00
abstract:AIMS:The aim of the study was to investigate the atrial myocardial deformation properties using ultrasound strain rate (SR) imaging in patients after catheter ablation of atrial fibrillation (AF) and to compare its prognostic value in maintaining sinus rhythm. METHODS AND RESULTS:A total of 118 patients with AF (74 pa...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehn168
更新日期:2008-06-01 00:00:00