Abstract:
BACKGROUND:The CAPTIM trial suggested a survival benefit of prehospital fibrinolysis (FL) compared to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) with a presentation delay of <2 hours. We examined the relationship between reperfusion strategy and time from symptom onset on 1-year mortality in a combined analysis of 1,168 patients with STEMI. METHODS:Individual patient data from CAPTIM (n = 840, 1997-2000) and the more recent WEST trial (n = 328, 2003-2005) were pooled. RESULTS:Median age was 58 years, 81% were men, and 41% had anterior myocardial infarction; 640 patients were randomized to FL versus 528 patients to PCI. Both arms received contemporary adjunctive medical therapy. Presentation delay (ie, symptom onset to randomization) was similar in FL and PCI patients (median 105 [72-158] vs 106 [74-162] minutes, P = .712). Rescue PCI after FL occurred in 26% and 27%, and 30-day PCI, in 70% and 71% in CAPTIM and WEST, respectively. Mortality was not different between FL and PCI (4.6% vs 6.5%, P = .263); however, the interaction between presentation delay and treatment was significant (P = .043). Benefit with FL was observed with time <2 hours (2.8% [FL] vs 6.9% [PCI], P = .021, hazard ratio [HR] 0.43, 95% CI 0.20-0.91), whereas beyond 2 hours, no treatment difference was observed (6.9% [FL] vs 6.0% [PCI], P = .529, HR 1.23, 95% CI 0.61-2.46). CONCLUSIONS:A strategy of early FL demonstrated a reduction in 1-year mortality compared to primary PCI in early presenters. Time from symptom onset should be a key consideration when selecting reperfusion therapy for STEMI.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Westerhout CM,Bonnefoy E,Welsh RC,Steg PG,Boutitie F,Armstrong PWdoi
10.1016/j.ahj.2010.10.033subject
Has Abstractpub_date
2011-02-01 00:00:00pages
283-90issue
2eissn
0002-8703issn
1097-6744pii
S0002-8703(10)00933-6journal_volume
161pub_type
杂志文章,随机对照试验abstract::Currently available antiplatelet agents are limited in the scope and magnitude of platelet inhibition. Orally active platelet glycoprotein IIb/IIIa antagonists are currently in clinical testing. These agents may extend platelet inhibition and clinical benefit from parenteral glycoprotein IIb/IIIa antagonists. The most...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1053/hj.1999.v138.99080
更新日期:1999-07-01 00:00:00
abstract::Right- and left-sided endocarditis are two distinct entities, both clinically and experimentally. As such, they require different clinical approaches. The accurate diagnosis of right-sided endocarditis rests largely on a high index of suspicion which is often raised in the case of an intravenous drug abuser with fever...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90564-8
更新日期:1986-01-01 00:00:00
abstract::One hundred two patients with evolving myocardial infarction of 6 hours' duration were given aspirin and intravenous heparin and randomly allocated to intravenous front-loaded, weight-adjusted rTPA administration over a 90-minute period (52 patients) or to two 15 mg doses of recombinant staphylokinase, 30 minutes apar...
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(97)70127-3
更新日期:1997-08-01 00:00:00
abstract:BACKGROUND:Circulating mediators, including thromboxane A2, the vasoconstrictor, platelet aggregant, and smooth muscle mitogen, may contribute to the progression of vascular narrowing in primary pulmonary hypertension (PPH). METHODS:To further understand the contribution of thromboxane and to provide novel therapy for...
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:10.1067/mhj.2002.121806
更新日期:2002-05-01 00:00:00
abstract:OBJECTIVES:To define the incidence and cumulative risk of atrial fibrillation (AF) in a population-based cohort of whites and African Americans. BACKGROUND:African-Americans reportedly have a lower risk of AF than whites despite their higher exposure to AF risk factors. However, precise estimates of AF incidence in Af...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2009.05.010
更新日期:2009-07-01 00:00:00
abstract::Under electrophysiologic studies, 44 asymptomatic chagasic individuals were studied. The mean age was 39.9 years, with 26 being male. The surface ECG showed normal tracings in 12 patients, left anterior fascicular block in three, incomplete right bundle branch block in two, and right bundle branch block in 27 (isolate...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90206-5
更新日期:1983-08-01 00:00:00
abstract::One hundred four patients (101 men, three women), under 40 years of age, with myocardial infarction (MI), underwent coronary arteriography. Eighty patients had significant obstructive coronary artery disease (CAD) (group 1), 23 had normal coronary arteries (group 2), and one patient had coronary ostial stenosis as a r...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90680-0
更新日期:1986-07-01 00:00:00
abstract:BACKGROUND:Coronary calcium detected noninvasively is an attractive way to diagnose atherosclerosis before the development of symptoms. This study examines the prognostic value of coronary calcium in asymptomatic subjects with usual cardiovascular risk. METHODS AND RESULTS:In 425 asymptomatic subjects, 229 men (aged 4...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2003.169
更新日期:2003-03-01 00:00:00
abstract::There are a number of important drug interactions with amiodarone. This agent appears to have a marked effect on the kinetics of some commonly used cardiovascular drugs, such as warfarin, digoxin, quinidine, and procainamide, and has dynamic interactions with others, such as the beta blockers and some calcium antagoni...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90017-0
更新日期:1983-10-01 00:00:00
abstract::We attempted to predict successful myocardial reperfusion and salvage in acute myocardial infarction (AMI) by using measurements of plasma superoxide dismutase (SOD), a plasma free-radical scavenger, activity. Forty-nine patients with AMI were studied within 6 hours of symptoms onset. In group 1 (n = 26), primary perc...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90163-5
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:Assessment of left ventricular (LV) thrombosis risk after acute myocardial infarction (AMI) is important because of potential embolic sequelae that are reduced by oral anticoagulant agents. The goal of this study was to investigate whether early assessment of LV systolic and diastolic performance with pulsed...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/j.ahj.2004.05.025
更新日期:2004-12-01 00:00:00
abstract::Free fatty acids (FFA), the predominant myocardial energy substrate, are present in increased quantities immediately following acute myocardial infarction (AMI) and may cause deleterious alterations in cardiac rhythm, oxygen consumption, and mechanical performance. In an attempt to suppress FFA and simultaneously incr...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-8703(76)80043-9
更新日期:1976-10-01 00:00:00
abstract:BACKGROUND:Noninvasive estimation of pulmonary capillary wedge pressure (PCWP) with Doppler-derived mitral inflow pattern has been shown to correlate well with invasively measured PCWP; however, it has not yet been determined whether Doppler-derived mitral inflow pattern can be used to estimate PCWP accurately in heart...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(98)70280-7
更新日期:1998-04-01 00:00:00
abstract:BACKGROUND:Chronic infection with Chlamydia pneumoniae (Cpn) has been associated with atherosclerotic cardiovascular disease in sero-epidemiological, pathological and animal-model studies. Inflammation and immune activation has been proposed as the pathophysiological link between chronic infection and atherosclerosis. ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/S0002-8703(03)00101-7
更新日期:2003-07-01 00:00:00
abstract:BACKGROUND:According to a recent meta-analysis, parathyroid hormone (PTH) excess is associated with increased cardiovascular disease (CVD) risk, but existing studies are limited. We examined in a prospective study the association of PTH with the incidence of CVD, taking into account vitamin D and other confounding vari...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2014.04.017
更新日期:2014-09-01 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:There is interest in measuring and comparing outcomes of percutaneous transluminal coronary angioplasty (PTCA) other than death, but there are no accepted methods for adjusting these outcomes for preprocedure differences in populations. We sought to identify independent predictors of functional outcome after...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(99)70142-0
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:Pacing leads with a small electrode surface for high-impedance stimulation have been shown to prolong pacemaker longevity, but no sufficient data is available on the safety and feasibility of a defibrillation lead with this novel design. METHODS:We evaluated the clinical performance of a tined, steroid-elut...
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(03)00411-3
更新日期:2003-12-01 00:00:00
abstract:BACKGROUND:Patients undergoing percutaneous coronary intervention (PCI) for unstable coronary syndromes have substantial emotional and spiritual distress that may promote procedural complications. Noetic (nonpharmacologic) therapies may reduce anxiety, pain and distress, enhance the efficacy of pharmacologic agents, or...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/mhj.2001.119138
更新日期:2001-11-01 00:00:00
abstract:BACKGROUND:Chocolate consumption has been inconsistently associated with risk of atrial fibrillation (AF). We investigated the association between chocolate consumption and risk of AF in Swedish adults from two cohort studies and conducted a meta-analysis to summarize available evidence from cohort studies on this topi...
journal_title:American heart journal
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.ahj.2017.09.013
更新日期:2018-01-01 00:00:00
abstract::Angina pectoris before and after MI was evaluated in a sample of 729 men and women from a general population in whom MI developed during a 36-year period of follow-up. Relations of AP to subsequent CHD events and mortality after initial MI were analyzed by proportional hazards regression models and were adjusted for c...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90406-8
更新日期:1996-07-01 00:00:00
abstract:BACKGROUND:Selenium is a central determinant of antioxidative glutathione peroxidase 1 (GPx-1) expression and activity. The relevance of selenium supplementation on GPx-1 in coronary artery disease (CAD) needs to be established. We assessed the effect of selenium supplementation on GPx-1 in cell culture and on endothel...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2008.09.004
更新日期:2008-12-01 00:00:00
abstract::The long-term prognosis of patients successfully resuscitated from cardiac arrest who do not have acute precipitating factors and in whom ventricular arrhythmias cannot be induced during baseline electrophysiologic testing is controversial. The purpose of this investigation was to evaluate the long-term risk of recurr...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(90)90245-s
更新日期:1990-12-01 00:00:00
abstract:OBJECTIVE:Implantation of drug-eluting stents has emerged as the predominant percutaneous revascularization strategy in diabetic patients, despite limited outcomes data. Accordingly, our aim was to conduct a meta-analysis to assess the benefit and safety profile of drug-eluting stents in diabetic patients. METHODS:We ...
journal_title:American heart journal
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.ahj.2007.11.017
更新日期:2008-04-01 00:00:00
abstract:BACKGROUND:Many US studies have documented an association between operator volume and outcomes after percutaneous coronary intervention (PCI). No study has assessed whether this relationship exists in Canada, where PCI is performed only at a limited number of regional centers and operator volumes are higher. METHODS:A...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2005.07.033
更新日期:2006-04-01 00:00:00
abstract:BACKGROUND:Diastolic heart failure (DHF) is characterized by dyspnea due to increased left ventricular (LV) filling pressures during stress. We sought the relationship of exercise-induced increases in B-type natriuretic peptide (BNP) to LV filling pressures and parameters of cardiovascular performance in suspected DHF....
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.02.012
更新日期:2004-08-01 00:00:00
abstract::In vitro studies have established that intravascular ultrasound is a reliable technique for accurate assessment of vascular anatomic structure and disease conditions before and after intervention. In addition, quantitative data from intravascular ultrasound studies correspond well with histologic findings, which serve...
journal_title:American heart journal
pub_type: 社论,评审
doi:10.1016/s0002-8703(96)90263-x
更新日期:1996-09-01 00:00:00
abstract::Stress has been identified as contributing to the development of cardiovascular disease. The pathophysiologic link between stress and disease still remains unclear. Because experimental stress testing in the laboratory permits the examination of the underlying mechanism for stress-induced blood pressure, analyses of c...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90560-1
更新日期:1988-08-01 00:00:00
abstract:BACKGROUND:Improvement in risk stratification of patients with non-ST-segment elevation acute coronary syndrome (ACS) is a gateway to a more judicious treatment. This study examines whether the routine determination of left ventricular ejection fraction (EF) adds significant prognostic information to currently recommen...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2004.09.027
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:Procedural volume has been shown to be associated with outcome in cardiac catheterization and intervention in adults. The impact of center-level factors (such as volume) and their interaction with subject- and procedure-level factors on outcome after cardiac catheterization in children is not well described....
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2015.02.018
更新日期:2015-06-01 00:00:00