Abstract:
OBJECTIVES:This study was done to test the hypothesis that a forced diuresis with maintenance of intravascular volume after contrast exposure would reduce the rate of contrast-induced renal injury. BACKGROUND:We have previously shown a graded relationship with the degree of postprocedure renal failure and the probability of in-hospital death in patients undergoing percutaneous coronary intervention. Earlier studies of singular prevention strategies (atrial natriuretic factor, loop diuretics, dopamine, mannitol) have shown no clear benefit across a spectrum of patients at risk. METHODS:A prospective, randomized, controlled, single-blind trial was conducted where 98 participants were randomized to forced diuresis with intravenous crystalloid, furosemide, mannitol (if pulmonary capillary wedge pressure <20 mm Hg), and low-dose dopamine (n = 43) versus intravenous crystalloid and matching placebos (n = 55). RESULTS:The groups were similar with respect to baseline serum creatinine (2.44+/-0.80 and 2.55+/-0.91 mg/dl), age, weight, diabetic status, left ventricular function, degree of prehydration, contrast volume and ionicity, and extent of peripheral vascular disease. The forced diuresis resulted in higher urine flow rate (163.26+/-54.47 vs. 122.57+/-54.27 ml/h) over the 24 h after contrast exposure (p = 0.001). Two participants in the experimental arm versus five in the control arm required dialysis, with all seven cases having measured flow rates <145 ml/h in the 24 h after the procedure. The mean individual change in serum creatinine at 48 h, the primary end point, was 0.48+/-0.86 versus 0.51+/-0.87, in the experimental and control arms, respectively, p = 0.87. There were no differences in the rates of renal failure across six definitions of renal failure by intent-to-treat analysis. However, in all participants combined, the rise in serum creatinine was related to the degree of induced diuresis after controlling for baseline renal function, r = -0.36, p = 0.005. The rates of renal failure in those with urine flow rates greater than 150 ml/h in the postprocedure period were significantly lower, 8/37 (21.6%) versus 28/61 (45.9%), p = 0.03. CONCLUSIONS:Forced diuresis with intravenous crystalloid, furosemide, and mannitol if hemodynamics permit, beginning at the start of angiography provides a modest benefit against contrast-induced nephropathy provided a high urine flow rate can be achieved.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Stevens MA,McCullough PA,Tobin KJ,Speck JP,Westveer DC,Guido-Allen DA,Timmis GC,O'Neill WWdoi
10.1016/s0735-1097(98)00574-9subject
Has Abstractpub_date
1999-02-01 00:00:00pages
403-11issue
2eissn
0735-1097issn
1558-3597pii
S0735109798005749journal_volume
33pub_type
临床试验,杂志文章,随机对照试验abstract::Until recently, vitamin K antagonists were the only available oral anticoagulants, but with numerous limitations that prompted the introduction of new oral anticoagulants targeting the single coagulation enzymes thrombin (dabigatran) or factor Xa (apixaban, rivaroxaban, and edoxaban) and given in fixed doses without c...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
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abstract::Both activation of platelets and elevation of plasminogen activator inhibitor type 1 (PAI-1) activity in plasma have been associated with acute myocardial infarction. Growth factors from platelet alpha-granules have been shown to increase PAI-1 synthesis in liver and endothelial cells in culture. The present study was...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(91)90689-7
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pub_type: 杂志文章,多中心研究
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更新日期:2019-03-05 00:00:00
abstract:OBJECTIVES:We sought to compare anterograde and retrograde balloon dilation of severe aortic valve stenosis in neonates. BACKGROUND:There is a high incidence of iliofemoral artery complications after retrograde balloon dilation of the aortic valve in the neonate. Therefore, a nonarterial technique of catheter access t...
journal_title:Journal of the American College of Cardiology
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doi:10.1016/s0735-1097(97)00266-0
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abstract:OBJECTIVES:We sought to develop a high-yield canine model of sudden cardiac death (SCD). BACKGROUND:Because electrical stimulation is a powerful means to elicit nerve sprouting, we hypothesize that subthreshold electrical stimulation is more effective than nerve growth factor (NGF) infusion in inducing nerve sprouting...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
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更新日期:2013-02-12 00:00:00
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pub_type: 杂志文章
doi:10.1016/0735-1097(89)90573-1
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abstract:OBJECTIVES:The main goal of this study was to determine whether induction of an angerlike state can result in significant levels of T-wave alternans, a marker of electrical instability, in the normal and ischemic heart. BACKGROUND:Outbursts of anger have been implicated in the occurrence of myocardial infarction and s...
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更新日期:2000-11-01 00:00:00
abstract:BACKGROUND:Although cardiomyopathy has emerged as a leading cause of death in Duchenne muscular dystrophy (DMD), limited studies and therapies have emerged for dystrophic heart failure. OBJECTIVES:The purpose of this study was to model DMD cardiomyopathy using DMD patient-specific human induced pluripotent stem cell (...
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doi:10.1016/j.jacc.2019.12.066
更新日期:2020-03-17 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2014.08.039
更新日期:2014-11-18 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2012-12-18 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,meta分析
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更新日期:2002-01-02 00:00:00
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pub_type: 杂志文章
doi:10.1016/s0735-1097(00)01206-7
更新日期:2001-03-15 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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pub_type: 杂志文章
doi:10.1016/s0735-1097(85)80501-5
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journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2001-06-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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更新日期:2010-10-19 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(88)80048-2
更新日期:1988-09-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(85)80219-9
更新日期:1985-12-01 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2009.08.059
更新日期:2010-01-26 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(91)90651-o
更新日期:1991-06-01 00:00:00
abstract:OBJECTIVES:We investigated whether the serum markers of collagen turnover differed in various forms of atrial fibrillation (AF) and in sinus rhythm (SR) in humans. BACKGROUND:Structural alterations and fibrosis have been implicated in the generation and perpetuation of AF. METHODS:Serum C-terminal propeptide of colla...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2008.03.045
更新日期:2008-07-15 00:00:00
abstract:OBJECTIVES:We report our initial experience with percutaneous pulmonary valve replacement in animals with large pulmonary trunks, using a modified percutaneous approach. BACKGROUND:Percutaneous pulmonary valve replacement has recently been introduced, and early clinical experience has been reported. This technique is ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.10.037
更新日期:2004-03-17 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(95)00412-2
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to determine whether cilostazol reduces intimal hyperplasia in patients undergoing long zotarolimus-eluting stent implantation (stent length: ≥ 30 mm) for native long coronary lesions (length: ≥ 25 mm). BACKGROUND:Restenosis after drug-eluting stent implantation remains a signi...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jacc.2010.10.035
更新日期:2011-03-15 00:00:00
abstract::Double outlet right ventricle associated with complete atrioventricular (AV) canal is a rare malformation. Nine cases are reported. In this abnormality the anterior AV leaflet is undivided and free floating and the aortic and pulmonary orifices are in the same frontal plane. In four of the nine cases, the conus was bi...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(86)80057-2
更新日期:1986-08-01 00:00:00