Abstract:
BACKGROUND:The TRANSFER-AMI study demonstrated that early routine percutaneous coronary intervention post-fibrinolysis (pharmacoinvasive strategy) is superior to conservative management for ST-elevation myocardial infarction. However, it is not clear whether treatment efficacy differs between men and women. METHODS:In this pre-specified subgroup analysis, we compared the efficacy of a pharmacoinvasive strategy in men versus women with acute ST-elevation myocardial infarction who were randomized to a pharmacoinvasive versus standard management following fibrinolysis. The primary end point was a composite of death, recurrent myocardial infarction, recurrent ischemia, heart failure and shock at 30 days. We tested for treatment heterogeneity between men and women using the Breslow-Day test. We also performed multivariable analysis adjusting for GRACE risk score and its interaction with treatment assignment, and evaluated for death/recurrent myocardial reinfarction as a secondary outcome. RESULTS:Of the 1059 patients, 843 were men and 216 were women. Compared to men, women were older, had worse Killip class, higher GRACE risk score, and higher rates of death and death/myocardial reinfarction at 30 days. The primary end point did not differ significantly between men and women (13.4% vs 16.7%, P = .22). Compared to standard treatment, a pharmacoinvasive strategy was associated with a lower rate of the primary end point in men (17.5% vs 9.4%, respectively, P < .001), but not in women (16.2% vs 17.1%, P = .86). There was a trend toward an interaction between treatment assignment and sex for the composite primary end point (P = .06). After adjustment for the significant interaction between GRACE risk score and treatment (P < .001), there was no significant interaction between sex and treatment for all the end points (all P > .40). CONCLUSION:The borderline heterogeneity in treatment efficacy of a pharmacoinvasive strategy in men versus women was no longer evident after adjustment for the difference in baseline risk. This suggests that sex per se was not an important determinant of the efficacy of a pharmacoinvasive strategy. Owing to the small number of women in this trial, further study in this area is needed.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Bhan V,Cantor WJ,Yan RT,Mehta SR,Morrison LJ,Heffernan M,Fitchett D,Džavík V,Ducas J,Borgundvaag B,Cohen EA,Goodman SG,Yan ATdoi
10.1016/j.ahj.2012.05.022subject
Has Abstractpub_date
2012-09-01 00:00:00pages
343-50issue
3eissn
0002-8703issn
1097-6744pii
S0002-8703(12)00385-7journal_volume
164pub_type
杂志文章,随机对照试验abstract::The acute hemodynamic and electrophysiologic effects of flecainide in tachycardia-induced ventricular dysfunction were investigated using an animal model. Seven swine were initially (CON) evaluated by echocardiography and then by right heart catheterization and provocative electrical ventricular stimulation both befor...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90018-d
更新日期:1991-06-01 00:00:00
abstract::High degree AV block occurred in 144 of 843 patients consecutively admitted because of acute inferior myocardial infarction and was associated with more extensive myocardial damage and a higher mortality rate, as compared to those without AV block. Patients with power failure at the time of appearance of high degree A...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(80)90308-7
更新日期:1980-01-01 00:00:00
abstract::Selective inhibition of sinus node function offers the possibility to decrease heart rate and reduce myocardial oxygen consumption in patients with impaired cardiac function, if myocardial contractility is not further attenuated. To study the influence of a specific sinus node inhibitor on myocardial function, alinidi...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(05)80185-1
更新日期:1990-06-01 00:00:00
abstract:BACKGROUND:Kidney failure causes anemia and is associated with a very high risk of coronary heart disease (CHD). Mildly to moderately decreased kidney function is far more common and also is associated with an elevated prevalence of anemia and CHD risk. Recent data suggest an even higher risk of CHD when both condition...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2005.03.055
更新日期:2006-02-01 00:00:00
abstract:BACKGROUND:Whether low-molecular-weight heparin (LMWH) is superior to unfractionated heparin (UFH) in acute ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) remains unclear. METHODS:A total of 3,372 STEMI patients wh...
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.2009.12.041
更新日期:2010-04-01 00:00:00
abstract::Patients with intractable heart failure (New York Heart Association [NYHA] class III and IV) who were receiving maximal conventional treatment were enrolled in an outpatient program that included inotropic infusions, intensive patient education, and close follow-up. The effects of this approach to therapy were evaluat...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90315-4
更新日期:1996-10-01 00:00:00
abstract::Noninvasive risk assessment in survivors of AMI can effectively subdivide patients into groups with differing risk profiles after hospital discharge, but some patients at risk for late death or recurrent AMI may be incorrectly identified; data from cardiac catheterization and angiography provide complementary and gene...
journal_title:American heart journal
pub_type: 社论
doi:10.1016/0002-8703(91)90747-6
更新日期:1991-02-01 00:00:00
abstract:OBJECTIVES:Impedance monitoring has been proposed as a method to assess the adequacy of tissue heating during catheter ablation procedures. The purpose of this study was to evaluate the relation among initial impedance, fall in impedance, and electrode temperature during catheter ablation procedures. METHODS AND RESUL...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(98)70130-9
更新日期:1998-11-01 00:00:00
abstract:AIMS:Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. N...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2015.11.019
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Pulmonary vein antrum isolation (PVI) as a treatment of paroxysmal atrial fibrillation (AF) is associated with a high rate of success; however, outcomes for treating persistent and long-standing persistent AF with PVI alone are substantially lower and often require multiple procedures to maintain long-term f...
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.2015.09.019
更新日期:2015-12-01 00:00:00
abstract::Interatrial septal aneurysm (IASA) has been detected with increasing frequency since the advent of two-dimensional echocardiography (2DE). In this study, we investigated the prevalence, characteristics, and predisposing factors in IASA formation in 724 infants, children, and adolescents undergoing 2DE. Among this grou...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90927-6
更新日期:1987-05-01 00:00:00
abstract::The incremental advantage of transesophageal echocardiography was determined by comparing results of paired transthoracic and transesophageal echocardiographic examinations performed in 61 patients for evaluation of suspected infective endocarditis. According to clinical and pathologic data, 31 of 61 (51%) patients ha...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90519-2
更新日期:1992-03-01 00:00:00
abstract::Characteristics of color-coded Doppler imaging combined with two-dimensional and M-mode echocardiography in six patients with systolic-diastolic murmurs are reported. PDA, congenital absence of pulmonary valve leaflets, ventricular septal defect and aortic regurgitation, two ruptured aneurysms of sinus of Valsalva, an...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90551-5
更新日期:1987-12-01 00:00:00
abstract:BACKGROUND:Postinterventional cognitive dysfunction (PICD) is a known complication of coronary artery bypass grafting (CABG). However, it is largely unknown whether PICD occurs after coronary catheterization. METHODS:Neuropsychologic data were obtained from 37 patients who received coronary catheterization and 47 pati...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2011.07.021
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:P2Y12 receptor antagonist therapy is recommended in addition to ASA for up to 1 year after acute coronary syndrome to reduce ischemic events. In contrast, the benefit of long-term dual antiplatelet therapy beyond 1 year remains unclear. Ticagrelor is a potent, reversibly binding P2Y12 receptor-antagonist tha...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2013.12.020
更新日期:2014-04-01 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:Although quantification of the impact of treatment on survival remains the cornerstone of clinical research, the assessment of a broader range of disease outcomes is growing increasingly important. This manuscript provides an overview of the considerations made regarding quantification of a range of clinical...
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.2002.120775
更新日期:2002-04-01 00:00:00
abstract::Several autoimmune diseases have been associated with increased frequencies of specific histocompatibility (HLA) antigens, particularly for the D (DR) locus, that may be linked to immune response genes. Rheumatic valvular heart disease (RHD) has been postulated to have autoimmune features, but HLA associations have no...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90311-x
更新日期:1986-11-01 00:00:00
abstract::The influence of diltiazem on the hemodynamic effects of ouabain in 10 preinstrumented awake dogs was studied. Mean aortic pressure increased from 102 to 119 mm Hg with ouabain (p less than 0.05), an effect that was attenuated by pretreatment with diltiazem. The increase in systemic vascular resistance of 30% with oua...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90587-5
更新日期:1989-10-01 00:00:00
abstract::Left ventricular aneurysm has been associated with increased mortality rates. The Cardiac Arrhythmia Suppression Trial (CAST) database was used prospectively to assess (1) the prognostic significance of left ventricular (LV) aneurysm after myocardial infarction on mortality rates and (2) the relation of LV aneurysm to...
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:10.1016/0002-8703(94)90549-5
更新日期:1994-04-01 00:00:00
abstract::The recognition that the onset of cardiovascular events follows a circadian periodicity and is frequently triggered by physical or mental stresses has created new possibilities for disease prevention. Morning peaks in occurrence are now well-documented for acute myocardial infarction, sudden cardiac death, transient m...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(99)70390-x
更新日期:1999-04-01 00:00:00
abstract:BACKGROUND:The type of practitioners who use the standard exercise test is changing. Once a tool of the cardiologist, the standard exercise test is now being performed by internists and other noncardiologists. Because this change could be facilitated by computerization similar to the computerized interpretation program...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/s0002-8703(98)70233-9
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:Coronary artery disease (CAD) and, increasingly, diabetes are recognized as having an inflammatory basis. Membrane toll-like receptors (TLRs) activate signaling pathways that up-regulate inflammation. We evaluated whether the Asp299Gly polymorphism in the TLR4 gene, which impairs inflammatory responses, is a...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.05.049
更新日期:2004-12-01 00:00:00
abstract::The detection of premature ectopic beats coinciding with the T-wave of the antecedent beat is important for patient monitoring. In the method described here, the difficulties of direct measurement of QT time are avoided by evaluating the changes of QT time according to heart rate by use of a diode function generator. ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90191-x
更新日期:1975-06-01 00:00:00
abstract::The hemodynamic hallmark of hypertension is increased systemic vascular resistance, although this variable is usually not determined in hypertensive patients because it has generally required invasive procedures to measure cardiac output. Reliable, totally noninvasive methods are now available that measure cardiac out...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(88)90565-0
更新日期:1988-08-01 00:00:00
abstract::Left ventricular topography and diastolic and systolic functions were studied in 41 patients with essential hypertension (group 1) and 33 age-matched normal adults (group 2) by Doppler echocardiography. In group 1 54% had LV concentric hypertrophy, 19% had combined concentric hypertrophy and eccentric remodeling, and ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90560-6
更新日期:1994-04-01 00:00:00
abstract::To evaluate the potential for hyperbaric oxygen (HBO) to produce transient improvement in function in areas of myocardium ischemic at rest (hibernating myocardium), 24 patients were studied within 1 week of acute myocardial infarction. Results were compared with single-photon emission computed tomography (SPECT) thall...
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)90394-b
更新日期:1992-11-01 00:00:00
abstract::Fifteen patients who arrived between 6 and 24 hours after the onset of acute myocardial infarction and who were found to have totally occluded coronary arteries, received aspirin, heparin, and tissue plasminogen activator given over 3 hours. Eight patients were randomly assigned to receive intravenous prostaglandin E1...
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(94)90539-8
更新日期:1994-04-01 00:00:00
abstract::To determine whether mitral valve annulus displacement (MVAD) can be used to assess septal contractility in patients with paradoxical septal motion, we assessed four atrioventricular regions (septum, lateral wall, anterior wall, and inferior wall) by MVAD in 80 consecutive patients. The patients were divided into five...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90062-9
更新日期:1996-01-01 00:00:00
abstract:BACKGROUND:Stroke is a rare but serious event that complicates the course of patients with acute coronary syndromes (ACS). The type, outcome, and risk factors of stroke occurring in stabilized patients with ACS have not been previously reported. METHODS:We evaluated stroke incidence, subtypes, and outcomes, in additio...
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/j.ahj.2004.01.028
更新日期:2004-09-01 00:00:00