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::We previously reported that single-head SPECT imaging with teboroxime is feasible. However, excessive hepatic uptake in some patients may interfere with image interpretation. This study examined the feasibility of improving image quality by use of a preprocessing masking technique to subtract hepatic activity. A band ...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(92)90079-b
更新日期:1992-12-01 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::Standard evaluation of children with sinus node (SN) dysfunction cannot distinguish abnormal autonomic tone from intrinsic SN disease. This distinction has potentially important therapeutic and prognostic implications. Intrinsic heart rate (IHR)--the peak heart rate (HR) measured during pharmacologic combined autonomi...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(05)80331-x
更新日期:1990-04-01 00:00:00
abstract::The efficacy and safety of sotalol therapy for ventricular arrhythmias was evaluated in 133 patients with drug-refractory ventricular arrhythmias. All patients had baseline electrophysiologic studies before and after oral sotalol therapy. Sixty-six patients were discharged home, treated with sotalol (52 patients witho...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90008-3
更新日期:1996-11-01 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:BACKGROUND:We review our 10-year experience of mitral valve (MV) repair in comparison with MV replacement in the elderly for floppy mitral valves/mitral valve prolapse (FMV/MVP). The use of MV repair for this entity has not been fully utilized by surgeons. METHODS:Two hundred ninety-two consecutive patients aged > or ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.07.003
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVE:To examine the safety and efficacy of cangrelor in patients with single-vessel disease (SVD) and multi-vessel disease (MVD). BACKGROUND:Cangrelor, an intravenous, rapidly acting P2Y12 inhibitor, is superior to clopidogrel in reducing ischemic events among patients receiving percutaneous coronary intervention...
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.2017.02.031
更新日期:2017-06-01 00:00:00
abstract::The relationship between coronary artery size and left ventricular (LV) muscle mass was studied in 10 control subjects and in 10 patients with chronic mitral regurgitation before and 28 +/- 15 months after mitral valve surgery. Left and right coronary artery size was determined by quantitative coronary arteriography. ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90659-w
更新日期:1993-11-01 00:00:00
abstract:BACKGROUND:False positive rate (FPR) of the current basic life support (BLS) termination of resuscitation (TOR) rule in out-of-hospital cardiac arrest (OHCA) patients (not witnessed; no return of spontaneous circulation prior to transport; and no shocks were delivered) has been ethically challenging. We validated the c...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2019.04.003
更新日期:2019-07-01 00:00:00
abstract::We evaluated the long-term angiographic outcome of balloon angioplasty by comparing original and follow-up target coronary narrowing. Rather than using restenosis to determine outcome, as in most angioplasty studies, we took an unusual approach and analyzed outcome in terms that are commonly used in progression and re...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(97)70153-4
更新日期:1997-05-01 00:00:00
abstract::Three cases of apical left ventricular hypertrophy demonstrating a sequestered small left ventricular apical cavity with complete systolic and partial diastolic intraventricular obstruction are described. Doppler studies revealed that flow from the apical chamber is aborted during early systole with further emptying d...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90730-2
更新日期:1988-12-01 00:00:00
abstract::Atherosclerotic coronary artery disease is a serious clinical problem. Clinicians dealing with patients can make a diagnosis of coronary disease in several ways. Unfortunately all too often the diagnosis is made via sudden death or acute myocardial infarction. At other times the diagnosis is made by evaluation of pati...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(92)91039-4
更新日期:1992-05-01 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:BACKGROUND:In a previous study from a single center, radionuclide measures of collateral flow with technetium 99m sestamibi have been shown to be significantly associated with angiographic residual (antegrade and collateral) flow and independent predictors of final infarct size in acute myocardial infarction. This stud...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/s0002-8703(97)70046-2
更新日期:1997-10-01 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:BACKGROUND:Familial dilated cardiomyopathy (FDCM) is attributed to defects in cytoskeletal proteins, and different patterns of inheritance and phenotypic expressions according to assorted-protein modifications have been identified to date. We describe a clinical family study with 24 individuals in 3 generations affecte...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2003.141
更新日期:2003-02-01 00:00:00
abstract::The present experiments were conducted on isolated dog hearts to demonstrate that conduction disturbances can be induced in the bundle branches by transection of about 50 per cent of the cross-sectional area of the His bundle on the right or left side. The His bundle, the posterior and anterior divisions of left bundl...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(76)80117-2
更新日期:1976-09-01 00:00:00
abstract:BACKGROUND:Multiple genetic loci are associated with clinical cardiovascular (CV) disease and individual CV risk factors. Individuals with ideal levels of all major CV risk factors have very low risk for CV disease morbidity or mortality. Ideal levels of risk factors can be attained by lifestyle modifications; however,...
journal_title:American heart journal
pub_type: 杂志文章,meta分析
doi:10.1016/j.ahj.2015.12.022
更新日期:2016-05-01 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::To investigate the influence of intrinsic limb vasodilator capacity on exercise performance, limb reactive hyperemic flows and their relations to exercise capacity during upright bicycle exercise were examined in 52 patients with recent myocardial infarction. Reactive hyperemic flow was measured in the forearm and the...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90243-4
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:The activated coagulation time (ACT) is a rapid measurement of a patient's level of heparin anticoagulation during cardiac catheterization. Patients receiving warfarin therapy occasionally are seen at the catheterization laboratory for emergent procedures. The effects of warfarin on ACT activity have not bee...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(98)70223-6
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:The conventional use of 16-slice multidetector computed tomography (MDCT) remains somewhat limited for evaluating stenoses in vein graft distal anastomotic sites and in coronary arteries. We investigated the diagnostic accuracy of 64-slice MDCT for assessment of both grafts and coronary arteries in patients ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2007.04.054
更新日期:2007-09-01 00:00:00
abstract::The hemodynamic effects of dopamine (DPM) and dobutamine (DBM) were compared in 13 patients with acute cardiogenic circulatory collapse. All patients presented with acute pump failure and inadequate systemic perfusion, and most were hypotensive. Nine patients had an acute myocardial infarction (AMI); the other four pa...
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(82)90562-2
更新日期:1982-06-01 00:00:00
abstract:BACKGROUND:Chronic total occlusion (CTO) recanalizations remain extremely challenging procedures. With improvements in technology and techniques, success rates for recanalization of CTO continue to improve. However, the clinical benefits of this practice remain unclear. The aim of the study was to determine the effecti...
journal_title:American heart journal
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.ahj.2010.04.015
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:In the setting of ST-segment elevation myocardial infarction, timely restoration of normal blood flow is associated with improved myocardial salvage and survival. Despite improvements in door-to-needle and door-to-balloon times, there remains an unmet need with respect to improved symptom-to-door times. A pr...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/j.ahj.2014.05.010
更新日期:2014-10-01 00:00:00
abstract::To determine whether cholinergic mechanisms contribute to blood pressure responses during arterial baroreflex inhibition and stimulation, we assessed the effects of atropine on pressor and depressor responses during and after release of the Valsalva maneuver, upon administration of intravenous phenylephrine and nitrog...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90837-8
更新日期:1984-05-01 00:00:00
abstract::Fingolimod, a sphingosine-1-phosphate receptor (S1PR) modulator, was the first oral disease-modifying therapy approved for relapsing forms of multiple sclerosis; it reduces autoreactive lymphocytes' egress from lymphoid tissues by down-regulating S1PRs. Sphingosine-1-phosphate signaling is implicated in a range of phy...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2014.06.028
更新日期:2014-11-01 00:00:00
abstract::One hundred patients inducible at electrophysiologic studies underwent serial drug testing with procainamide, lidocaine, and lorcainide to determine comparative efficacy. Acute intravenous administration was followed by repeat programmed electrical stimulation (PES) studies on separate days for each antiarrhythmic dru...
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)90412-0
更新日期:1985-01-01 00:00:00
abstract::In patients with essential hypertension, glomerular filtration rate remains normal or elevated, whereas renal blood flow tends to be lower, which results in an increased filtration fraction. The afferent (preglomerular) arteriolar resistance determines the fraction of the pressure that is transmitted to the glomerular...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(91)90945-e
更新日期:1991-10-01 00:00:00
abstract:BACKGROUND:Elevated C-reactive protein (CRP) is a common finding in patients with aortic stenosis (AS) and may be associated with rapid AS progression and worse outcome. The purpose of the study was to examine the role of high-sensitivity CRP and its interaction with rosuvastatin on the progression of AS. METHODS:We m...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2011.03.016
更新日期:2011-06-01 00:00:00