Abstract:
BACKGROUND:Glycoprotein (GP) IIb/IIIa inhibitors can improve outcomes in patients with non-ST-segment elevation acute coronary syndromes but raise the risk of bleeding, particularly if dosed in excess. The impact of GP IIb/IIIa dosing feedback on safety and major bleeding is unknown. METHODS:Glycoprotein IIb/IIIa dosing feedback was added to the CRUSADE quarterly site reports in the first quarter of 2006. We describe GP IIb/IIIa use and dosing among 25,641 patients with non-ST-segment elevation acute coronary syndromes from the fourth quarter of 2005 to the fourth quarter of 2006. RESULTS:Eleven thousand eight hundred forty-six patients received GP IIb/IIIa inhibitors, including 4,031 women and 2,609 elderly patients (age, ≥75 years). Among GP IIb/IIIa-treated patients, unadjusted rates of excess GP IIb/IIIa dosing declined overall (26.4%-22.4%, Ptrend=.01) and among the elderly (65.6%-52.1%, Ptrend<.001). After adjustment, declines in excess dosing remained significant only for the elderly, although more than half of GP IIb/IIIa-treated elderly patients continued to receive excess dosing at the end of the study period (64.1%-51.3%, Ptrend<.001). There were concurrent declines in unadjusted major bleeding rates overall (9.6%-8.0%, Ptrend=.02), but declines among women (14.4%-11.5%, Ptrend=.08) and the elderly (17.1%-11.0%, Ptrend=.05) did not reach statistical significance. After adjustment for baseline characteristics and excess dosing, declines in major bleeding rates were no longer significant overall or for any subgroup. CONCLUSION:Within 9 months of initiating a safety feedback program, we observed early decreases in excess GP IIb/IIIa dosing among the elderly but minimal changes in excess dosing overall. Further work is needed to promote safe and effective medication use in vulnerable patients who are most at risk of harm.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Mudrick DW,Chen AY,Roe MT,Newby LK,Gibler WB,Ohman EM,Peterson ED,Alexander KPdoi
10.1016/j.ahj.2010.08.008subject
Has Abstractpub_date
2010-12-01 00:00:00pages
1072-8issue
6eissn
0002-8703issn
1097-6744pii
S0002-8703(10)00754-4journal_volume
160pub_type
杂志文章,多中心研究abstract:BACKGROUND:Current guidelines recommend anticoagulation therapy during primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). However, whether anticoagulation should be continued after pPCI has not been well investigated. METHODS/DESIGN:The RIGHT trial is a prospectiv...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2020.06.005
更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:Women with X-chromosome monosomy or Turner syndrome (TS) are at increased risk for aortic dilation and dissection. To better understand the pathology and develop tools to monitor the risk of aortic disease, we investigated N-terminal pro-brain natriuretic peptide (BNP) (NT-proBNP) levels in women with TS and...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2012.06.021
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:Declines in case fatality post-myocardial infarction (MI) have been observed over the past 3 decades. Few studies report socioeconomic disparities in survival post-MI. METHODS:We assessed 1-year case fatality among 9,116 incident MI patients included in the Atherosclerosis Risk in Communities community surv...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2012.10.022
更新日期:2013-01-01 00:00:00
abstract::Exercise-induced changes in QRS duration were assessed in 25 normal subjects and in 17 patients with stable ischemic heart disease. None had bundle branch block or were taking medications, and all patients had angina pectoris induced during the test. QRS duration and ST60 amplitude were measured by computer during res...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90640-x
更新日期:1986-05-01 00:00:00
abstract::Two elderly patients with coronary heart disease, chronic pulmonary disease, and complex atrial arrhythmias are presented. The suction electrode technique for right atrium monophasic action potential recording was used. This recording allows better analysis of the atrial arrhythmias and estimates the stability of foca...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90126-x
更新日期:1975-08-01 00:00:00
abstract:BACKGROUND:The purpose of this investigation was to quantify the amount of intralesional calcium detected by intravascular ultrasound (IVUS) compared with undecalcified histology in human arteries. This method preserves intralesional calcium and reduces sectioning artifacts, thereby providing an accurate measure of cal...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(99)70496-5
更新日期:1999-03-01 00:00:00
abstract:BACKGROUND:Afterload reduction decreases volume overload on the left ventricle and may thereby delay the need for valve replacement in chronic asymptomatic aortic regurgitation. The aims of this randomized double-blind, placebo-controlled trial were to examine short- and long-term hemodynamic effects of felodipine in c...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-8703(00)90046-2
更新日期:2000-04-01 00:00:00
abstract::It has been shown that brief episodes of myocardial ischemia can render the heart more resistant to a prolonged subsequent ischemic episode. This phenomenon, called "preconditioning," has been described in human beings during coronary angioplasty with the use of clinical, electrocardiographic (ECG), or metabolic param...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(97)70200-x
更新日期:1997-04-01 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:BACKGROUND:Anginal chest pain without creatine kinase (CK) elevation is frequently observed in the first hours after coronary stenting. Possible causes of ischemic episodes are microembolism, side branch occlusion, coronary vasospasm, and disturbances of microvascular circulation. In a prospective, double-blind, random...
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:2000-01-01 00:00:00
abstract::Fifteen cases of the sick-sinus syndrome in young Negroes are presented. The etiology was unknown in all cases; organic heart disease was absent. The very high default rate suggests that the prognosis may be grave. This disorder is by no means uncommon in young persons in tropical countries and the dangers of a mistak...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90078-2
更新日期:1975-03-01 00:00:00
abstract::Sixty-five patients with dilated cardiomyopathy were studied by means of 24-hour ECG monitoring. Ventricular arrhythmias were present in 62 (95.4%), of whom 52 (80%) showed a complex form (multiform ventricular extrasystoles, pairs, and ventricular tachycardia). Forty-one patients, presenting with complex ventricular ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90711-3
更新日期:1987-03-01 00:00:00
abstract::With the availability of percutaneous transluminal coronary angioplasty (PTCA), the management of patients who present with recurrent angina following coronary artery bypass surgery (CABG) has changed. From January 1987 to December 1988, 149 symptomatic post CABG patients underwent coronary angiography at our institut...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(90)90121-d
更新日期:1990-11-01 00:00:00
abstract:BACKGROUND:Optimal antithrombotic treatment after transcatheter aortic valve replacement (TAVR) is unknown and determined empirically. The direct factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related thrombotic complications and premature valve failure. DESIGN:GALILEO is an international, randomized, ope...
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.2016.10.017
更新日期:2017-02-01 00:00:00
abstract::Baroreflex modulation of forearm vascular resistance (FVR) has been reported to be abnormal in patients with congestive heart failure (CHF). However, the neurohumoral mechanisms for this impairment are not defined. We assessed the responses of arterial pressure, FVR, plasma norepinephrine, and plasma renin activity to...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90075-6
更新日期:1989-07-01 00:00:00
abstract:OBJECTIVES:The objective of this study is to assess trends in evidence-based therapy use and short- and long-term mortality over time among older patients with non-ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND:With the prevalence of national quality improvement efforts, the use of evidence-based ther...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2013.10.008
更新日期:2014-01-01 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:After the Mustard or Senning procedure, adults with transposition of the great arteries may have right ventricular failure and require consideration of new therapies. A 2-stage arterial switch operation (ASO) may be performed as an alternative to heart transplantation. This procedure is relatively successful...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2003.09.015
更新日期:2004-03-01 00:00:00
abstract::Percutaneous transluminal balloon angioplasty for stenosis of the aorta was performed in 36 patients with Takayasu's arteritis (age range, 8 to 36 years; mean, 19.1 +/- 7.7 years). Balloon dilatation was successful in 34 patients and resulted in a decrease in the mean peak systolic pressure gradient (PSG) from 75.2 +/...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90967-z
更新日期:1992-10-01 00:00:00
abstract:BACKGROUND:Heart failure (HF) remains a major public health issue. Data on long-term trends in the incidence of HF and survival after its onset are limited. METHODS:A prospective cohort study conducted between 1985 and 2004 in 21,906 participants of the Physicians' Health Study I who were alive and free of HF on Janua...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2007.07.004
更新日期:2007-11-01 00:00:00
abstract::Percutaneous transluminal coronary angioplasty (PTCA) has, in general, been restricted to therapy for patients with angina pectoris. Thrombolytic therapy and guide wire recanalization have been used to recanalize coronary arteries in patients with evolving myocardial infarction. Recently we and others have examined th...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90352-1
更新日期:1984-04-01 00:00:00
abstract::Age is a recognized risk factor for coronary artery disease, but the relationship between age and silent ischemia is not well understood. We analyzed the data from 35 rest/stress radionuclide ventriculography examinations in patients with documented ischemic coronary artery disease who had experienced 1 mm ST segment ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(90)90156-r
更新日期:1990-07-01 00:00:00
abstract::This review focuses on selected aspects of the treatment of patients being evaluated for and undergoing cardiac transplantation. Cardiac transplantation is a potential therapeutic option for a variety of irreversible cardiac disorders when the symptomatic status and anticipated survival after transplantation exceeds t...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(95)90288-0
更新日期:1995-03-01 00:00:00
abstract:BACKGROUND:Although controversial, reducing low-density lipoprotein cholesterol (LDL-C) to target levels remains a common therapeutic goal after acute myocardial infarction (AMI). We sought to illuminate patient and provider characteristics associated with LDL-C goal nonattainment after AMI. METHODS:In an observationa...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2012.10.005
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Stroke in patients with heart failure is associated with poor outcomes. Risk stratification schemes may improve clinical decision making in this patient population. This study investigated whether female sex is a risk factor for stroke in patients with heart failure in sinus rhythm. METHODS:This is a popula...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2014.12.004
更新日期:2015-03-01 00:00:00
abstract::Atrial fibrillation is a common disease of the elderly, conferring considerable morbidity and mortality related to cardiovascular effects and thromboembolic risks. Anticoagulation, antiarrhythmic medications, and rate control are the cornerstone of contemporary management, whereas ablation and evolving surgical techni...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2014.12.015
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Stroke prevention in anticoagulation-naïve patients with atrial fibrillation undergoing cardioversion has not been systematically studied. OBJECTIVE:To determine outcomes in anticoagulation-naïve patients (defined as those receiving an anticoagulant for <48 hours during the index episode of atrial fibrillat...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2016.06.008
更新日期:2016-09-01 00:00:00
abstract::The efficacy of chronic ambulatory captopril (CPT) therapy was evaluated over an 18-month period in 36 patients with refractory chronic congestive heart failure (CHF) by cardiac catheterization, treadmill exercise, nuclear scintigraphy, echocardiography, and symptomatology. Clinical improvement to New York Heart Assoc...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(82)90043-6
更新日期:1982-11-01 00:00:00
abstract:INTRODUCTION:Heart Failure (HF) is a common cause of hospitalization in older adults. The transition from hospital to home is high-risk, and gaps in transitional care can increase the risk of re-hospitalization and death. Combining health care services supported by meta-analyses, we designed the PACT-HF transitional ca...
journal_title:American heart journal
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.ahj.2017.12.013
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:We aimed to study the comparative safety and effectiveness of various antithrombotic treatment strategies among older adults with non-ST elevation myocardial infarction (NSTEMI) and atrial fibrillation (AF). METHODS:Using the CRUSADE registry linked to longitudinal Medicare claims data, we examined NSTEMI p...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2012.01.017
更新日期:2012-04-01 00:00:00