Abstract:
BACKGROUND:Experimental studies suggest that metabolic myocardial support by intravenous (IV) glucose, insulin, and potassium (GIK) reduces ischemia-induced arrhythmias, cardiac arrest, mortality, progression from unstable angina pectoris to acute myocardial infarction (AMI), and myocardial infarction size. However, trials of hospital administration of IV GIK to patients with ST-elevation myocardial infarction (STEMI) have generally not shown favorable effects possibly because of the GIK intervention taking place many hours after ischemic symptom onset. A trial of GIK used in the very first hours of ischemia has been needed, consistent with the timing of benefit seen in experimental studies. OBJECTIVE:The IMMEDIATE Trial tested whether, if given very early, GIK could have the impact seen in experimental studies. Accordingly, distinct from prior trials, IMMEDIATE tested the impact of GIK (1) in patients with acute coronary syndromes (ACS), rather than only AMI or STEMI, and (2) administered in prehospital emergency medical service settings, rather than later, in hospitals, after emergency department evaluation. DESIGN:The IMMEDIATE Trial was an emergency medical service-based randomized placebo-controlled clinical effectiveness trial conducted in 13 cities across the United States that enrolled 911 participants. Eligible were patients 30 years or older for whom a paramedic performed a 12-lead electrocardiogram to evaluate chest pain or other symptoms suggestive of ACS for whom electrocardiograph-based acute cardiac ischemia time-insensitive predictive instrument indicated a ≥75% probability of ACS, and/or the thrombolytic predictive instrument indicated the presence of a STEMI, or if local criteria for STEMI notification of receiving hospitals were met. Prehospital IV GIK or placebo was started immediately. Prespecified were the primary end point of progression of ACS to infarction and, as major secondary end points, the composite of cardiac arrest or in-hospital mortality, 30-day mortality, and the composite of cardiac arrest, 30-day mortality, or hospitalization for heart failure. Analyses were planned on an intent-to-treat basis, on a modified intent-to-treat group who were confirmed in emergency departments to have ACS, and for participants presenting with STEMI. CONCLUSION:The IMMEDIATE Trial tested whether GIK, when administered as early as possible in the course of ACS by paramedics using acute cardiac ischemia time-insensitive predictive instrument and thrombolytic predictive instrument decision support, would reduce progression to AMI, mortality, cardiac arrest, and heart failure. It also tested whether it would provide clinical and pathophysiologic information on GIK's biological mechanisms.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Selker HP,Beshansky JR,Griffith JL,D'Agostino RB,Massaro JM,Udelson JE,Rashba EJ,Ruthazer R,Sheehan PR,Desvigne-Nickens P,Rosenberg YD,Atkins JM,Sayah AJ,Aufderheide TP,Rackley CE,Opie LH,Lambrew CT,Cobb LA,Macleod BAdoi
10.1016/j.ahj.2012.02.002subject
Has Abstractpub_date
2012-03-01 00:00:00pages
315-22issue
3eissn
0002-8703issn
1097-6744pii
S0002-8703(12)00086-5journal_volume
163pub_type
杂志文章,多中心研究,随机对照试验abstract:BACKGROUND:Endothelial injury plays a critical role in coronary artery disease (CAD), but the assessment of this injury has been problematical. Recently, it has been shown in vitro that endothelial cells (ECs) release endothelial microparticles (EMPs) on activation or apoptosis and that an assay of EMPs can provide use...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/S0002-8703(03)00103-0
更新日期:2003-06-01 00:00:00
abstract::Angiographic evidence of coronary dissection after angioplasty is found in 25% to 30% of cases. Although patients are usually asymptomatic, in a small percentage angioplasty-induced coronary dissection results in luminal impairment and ischemic complications. The present study was undertaken to identify factors respon...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(07)80008-1
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:The CPORT-E trial showed the noninferiority of nonprimary percutaneous coronary intervention (PCI) at hospitals without cardiac surgery on-site (SoS) compared with hospitals with SoS for 6-week mortality and 9-month major adverse cardiac events (MACE). However, target vessel revascularization (TVR) was incre...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2017.10.023
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:With one-quarter of initial myocardial infarctions (MI) being unrecognized MI (UMI), recognition is critical to minimize further cardiovascular risk. Diabetes mellitus is an established risk factor for UMI. If impaired fasting glucose (IFG) also increased the risk for UMI, it would represent a significant pu...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2015.08.003
更新日期:2015-11-01 00:00:00
abstract:BACKGROUND:Over the past decade, electronic health records (EHRs) have emerged as a potential tool to assess quality of care; however, the feasibility and accuracy of EHRs to assess adherence to lipid management performance measures have not been evaluated. METHODS:We created a retrospective cohort of 3779 patients wi...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2013.07.024
更新日期:2013-10-01 00:00:00
abstract:OBJECTIVE:To date, few studies have evaluated asymptomatic patients with organic mitral regurgitation (MR). The goal of the present study was to assess the presence of independent predictive factors for progression of symptoms and/or left ventricular dysfunction (SLVSD) in this population. METHODS:We prospectively eva...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2006.01.015
更新日期:2006-11-01 00:00:00
abstract::The antihypertensive efficacy, safety, and lipid effects of doxazosin, a selective alpha 1-inhibitor, were assessed in a general practice setting. Three hundred twenty-six patients were entered into the study, which involved three phases: (1) a 2-week baseline period, (2) an 8-week period in which patients received 1 ...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(91)90857-e
更新日期:1991-01-01 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:This study was designed to investigate the efficacy of alteplase double-bolus dosing compared with the front-loaded 90-minute infusion regimen in patients with acute myocardial infarction. Recent pilot studies have suggested that bolus dosing may provide improved efficacy in establishing early, complete, and...
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)70024-9
更新日期:1998-10-01 00:00:00
abstract::To determine whether a dose of 5 mg of nifedipine would be useful in the treatment of hypertensive emergencies, we compared the acute hypotensive effects of two different doses of nifedipine, 5 mg and 10 mg, in patients with severe hypertension. In this prospective, randomized, double-blind study, 30 consecutive black...
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(92)90283-2
更新日期:1992-09-01 00:00:00
abstract:BACKGROUND:The optimal antiplatelet regimen in elective patients undergoing complex percutaneous coronary interventions (PCIs) is uncertain. We aimed to assess the impact of glycoprotein IIb/IIIa (GpIIb/IIIa) inhibition with eptifibatide in clinically stable subjects with diffuse coronary lesions. METHODS:Patients wit...
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.2012.02.009
更新日期:2012-05-01 00:00:00
abstract:BACKGROUND:Diabetes is associated with a high rate of events after acute coronary syndrome and percutaneous coronary intervention despite aspirin treatment. Once daily aspirin might not provide 24-hour stable biological efficacy in patients with diabetes. We compared the biological efficacy of the same daily dose of as...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2012.06.008
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:Depressive symptoms in patients with heart failure (HF) are common and might be associated with inflammation. No studies have examined both the cross-sectional and prospective association between inflammation and depressive symptoms in patients with HF with adequate correction for disease severity. The aim o...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2011.03.011
更新日期:2011-06-01 00:00:00
abstract::The efficacy of mexiletine used alone, and in combination with a class Ia antiarrhythmic drug, was assessed in 159 previously drug-refractory patients with ventricular tachycardia (VT) during serial electrophysiologic studies and during long-term (5-year) clinical follow-up. Electrically-inducible ventricular tachycar...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90482-6
更新日期:1988-02-01 00:00:00
abstract::The response of the right ventricle to exercise was examined in 19 patients with heart disease by constructing right ventricular function curves and determining the relationship between right ventricular afterload and preload. Simultaneous cardiac output and right heart pressures were measured at rest, during exercise...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90354-x
更新日期:1983-03-01 00:00:00
abstract::Vasodilators facilitate ventricular emptying by affording earlier onset of left ventricular (LV) ejection and increased stroke volume with achievement of a reduced end-systolic pressure and volume. Agents with positive inotropic properties increase stroke volume by shifting the end-systolic pressure-volume curve to th...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(81)90738-9
更新日期:1981-09-01 00:00:00
abstract:BACKGROUND:Calcified lesions carry the risk of suboptimal stent expansion. The purpose of this study was to investigate the impact of target lesion calcification on intracoronary ultrasound (ICUS) guided stent expansion after rotational atherectomy. METHODS:Stent expansion was assessed by ICUS in 39 patients with the ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(99)70463-1
更新日期:1999-01-01 00:00:00
abstract::To evaluate regional differences in thickness and systolic function of human myocardium perfused by angiographically normal coronary arteries in valvular and ischemic heart disease, we performed intraoperative epicardial M-mode mapping of ventriculographically normal wall regions (perfused by normal coronary arteries)...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90273-5
更新日期:1986-08-01 00:00:00
abstract::Frequency-domain analysis of heart rate variability (HRV) appears to distinguish sympathetic and parasympathetic modulation of heart rate. The effects of acute reflex, as opposed to tonically augmented, cardiac vagal tone on HRV are not clearly defined. Power spectral components of HRV were measured in 36 patients und...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(95)90143-4
更新日期:1995-12-01 00:00:00
abstract::Atherosclerosis and its vascular sequela are responsible for considerable morbidity and mortality rates. Several risk factors have been implicated in the pathogenesis of atherosclerosis, and the search for other risk factors continues on the medical horizon. Renin-angiotensin system (RAS), a multienzyme, multilocale a...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(97)70089-9
更新日期:1997-09-01 00:00:00
abstract:BACKGROUND:Aldosterone antagonist therapy is recommended for selected patients with heart failure and reduced ejection fraction. Adherence to therapy in the transition from hospital to home is not well understood. METHODS:We identified patients with heart failure and reduced ejection fraction who were ≥65 years old, e...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2013.03.007
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:The prodrug clopidogrel requires activation by cytochrome P-450 (CYP) enzymes for its antiplatelet effect. The genes encoding enzymes for clopidogrel activation are polymorphic, leading to reduced or increased function, depending on the respective genotype. Reduced-function alleles have been associated with ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2010.06.039
更新日期:2010-09-01 00:00:00
abstract::Plasma cholesterol levels were measured in 15,892 participants of a cholesterol screening in Hartford, Connecticut. The screenees were typically health conscious as evidenced by the low prevalence of current cigarette smoking (12%). However, more than 25% of the men and 35% of the women over the age of 50 years had ch...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90741-2
更新日期:1989-03-01 00:00:00
abstract::Electrolyte balance has been regarded as a factor important to cardiovascular stability, particularly in congestive heart failure. Among the common electrolytes, the significance of magnesium has been debated because of difficulty in accurate measurement and other associated factors, including other electrolyte abnorm...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(96)90253-7
更新日期:1996-09-01 00:00:00
abstract::Contrast bidimensional echocardiographic (2DE) studies were performed in eight patients with d-transposition of the great vessels in the postoperative period of the Senning technique. Contrast was injected into a peripheral vein of all patients, and into the arterial atrium in five in the postoperative period. The 2DE...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90552-0
更新日期:1984-07-01 00:00:00
abstract::Fasting mongrel dogs underwent hyperbaric oxygen treatment (HBOT), recombinant tissue plasminogen activator (rt-PA) treatment, and simultaneous HBOT and rt-PA treatment following prior experimental left anterior descending coronary artery occlusion for 2 hours. Thrombosis in and around a copper coil was recorded angio...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(90)90194-3
更新日期:1990-10-01 00:00:00
abstract:BACKGROUND:Advanced age is a well-established prognostic risk factor after acute myocardial infarction (AMI), yet approximately 10% of MIs occur in patients <45 years. We examined characteristics, cardiovascular outcomes, and the influence of risk factors on outcomes in young survivors of AMI. METHODS:Fourteen thousan...
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.2007.11.016
更新日期:2008-04-01 00:00:00
abstract::Traditionally, assessment of therapy has been judged by the ability of treatment to alleviate symptoms with tolerable side effects or toxicity. In recent years, it has become obvious that more subtle and patient-oriented approaches are urgently needed to evaluate progression of cardiovascular disease and to monitor th...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90963-x
更新日期:1987-07-01 00:00:00
abstract:BACKGROUND:The same electrocardiographic (ECG) criteria that have been used for detection of left ventricular hypertrophy (LVH) have recently been recognized as predictors of adverse clinical outcomes, but this predictive ability is inadequately explored and understood. METHODS:A total of 14,984 participants from the ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2015.04.004
更新日期:2015-07-01 00:00:00
abstract::Evaluation of mitral regurgitation is difficult whether invasive or noninvasive methods are used. The determination of the regurgitant volume itself cannot be done in clinical practice with reasonable accuracy. In six sheep with chronic mitral regurgitation, left ventricular and left atrial pressures were recorded wit...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(95)90009-8
更新日期:1995-02-01 00:00:00