Abstract:
OBJECTIVES:This study was designed to compare the long-term clinical and angiographic effects of successful directional atherectomy and stent implantation and to examine whether restenosis is related to the mechanism of lumen improvement as well as the extent of lumen gain. BACKGROUND:Directional atherectomy and coronary stent implantation have been shown to achieve a more optimal immediate result that may lead to a more favorable long-term angiographic outcome and fewer target vessel revascularizations than does angioplasty. However, it remains to be determined whether one of the devices used in these interventions provides consistently better results than the other. METHODS:To allow meaningful comparisons a prospectively collected series of 117 patients successfully treated with atherectomy were individually matched with a prospectively collected series of 117 patients successfully treated with stent implantation. Matching for baseline characteristics identified patients with identical lesion location and lesion severity, and immediate and late angiographic and clinical outcome were compared. To evaluate the possibility of a procedure effect on restenosis, patients were further matched for both immediate angiographic outcome and baseline characteristics, providing 150 matched patients for comparison. As confirmatory analysis, multivariate models were constructed to predict late lumen diameter. RESULTS:Matching resulted in two comparable groups with equivalent baseline clinical and stenosis characteristics (n = 117 pairs). Atherectomy led to a smaller immediate gain than stenting and, because late loss was similar in both groups, stenting resulted in a larger late lumen (1.96 +/- 0.51 vs. 1.66 +/- 0.55 mm, p < 0.0001). When patients were matched for immediate gain and baseline characteristics (n = 75 pairs), lumen loss was more pronounced after atherectomy, and thus the minimal lumen diameter at follow-up differed significantly between the two groups (1.66 +/- 0.53 vs. 1.90 +/- 0.47 mm, p = 0.004). This beneficial angiographic effect of stenting was accompanied by a reduced need for repeat interventions. Multivariate analysis confirmed the independent effect of the interventional device used, whereby less loss and greater lumen diameter at follow-up were predicted for stent implantation than for atherectomy. CONCLUSIONS:Successful stent implantation provided a more favorable long-term angiographic outcome and lower rates of restenosis and need for target lesion revascularization than did atherectomy. This favorable effect of stenting not only is related to a larger, immediate gain, but also seems to attenuate late lumen loss.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Umans VA,Melkert R,Foley DP,Serruys PWdoi
10.1016/0735-1097(96)00229-xsubject
Has Abstractpub_date
1996-09-01 00:00:00pages
637-44issue
3eissn
0735-1097issn
1558-3597pii
0735-1097(96)00229-Xjournal_volume
28pub_type
杂志文章abstract::The records of 90 patients with Wolff-Parkinson-White syndrome who presented with supraventricular tachycardia in the first 4 months of life were reviewed. Among these, 63% were male. Structural heart disease was present in 20%, most commonly Ebstein's anomaly. All patients presented with a regular narrow QRS tachycar...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(85)80095-4
更新日期:1985-01-01 00:00:00
abstract:OBJECTIVES:We sought to determine whether patients receiving chronic clopidogrel therapy undergoing nonemergent stenting who display high on-treatment preprocedural platelet aggregation measured by standard light transmittance aggregometry and thrombelastography (TEG) will be at increased risk for poststenting ischemic...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2006.10.050
更新日期:2007-02-13 00:00:00
abstract::The prevention of secondary vascular events is of paramount importance in patients with a history of stroke or transient ischemic attack (TIA). Most cardiologists are aware of the benefits of clopidogrel plus aspirin versus those of other antiplatelet regimens in patients with acute coronary syndrome. Using a represen...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.04.058
更新日期:2005-09-06 00:00:00
abstract:OBJECTIVES:We sought to investigate the impact of six months of cardiac resynchronization therapy (CRT) on echocardiographic variables of left ventricular (LV) function. BACKGROUND:Cardiac resynchronization therapy has recently been introduced as a new therapeutic modality in patients with advanced heart failure (HF) ...
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
doi:10.1016/s0735-1097(01)01637-0
更新日期:2001-12-01 00:00:00
abstract::Heart rate variability has been demonstrated both experimentally and clinically to be of prognostic importance in determining mortality after myocardial infarction. However, no paired studies have been reported to examine heart rate variability before and after myocardial infarction. The hypothesis was tested that low...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(10)80351-1
更新日期:1990-10-01 00:00:00
abstract:OBJECTIVES:We tested the hypothesis that salt and fluid retention in heart-transplant recipients (HTRs) is caused by a failure to reflexively suppress the renin-angiotensin-aldosterone system (RAAS). BACKGROUND:It is known that extracellular fluid volume is expanded (12% to 15%) in HTRs who develop hypertension. METH...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/s0735-1097(02)02822-x
更新日期:2003-02-05 00:00:00
abstract:OBJECTIVES:This study was designed to investigate the mutual effects of chronic atrial dilation and electrical remodeling on the characteristics of atrial fibrillation (AF). BACKGROUND:Both electrical remodeling and atrial dilation promote the inducibility and perpetuation of AF. METHODS:In seven goats AF was induced...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.09.041
更新日期:2006-02-07 00:00:00
abstract::Little is known about the benefits and risks of the long-term use of cardiovascular drugs. Evidence from randomized clinical trials (RCTs) rarely goes beyond a few years of follow-up, but patients are often given continuous treatment with multiple drugs well into old age. We focus on 4 commonly used cardiovascular dru...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2015.07.018
更新日期:2015-09-15 00:00:00
abstract:OBJECTIVES:The aim of the study was to screen 36 unrelated patients with hypertrophic cardiomyopathy (HCM; 16 familial and 20 sporadic cases) from a genetically homogeneous area in eastern Finland for variants in the cardiac beta-myosin heavy chain (beta-MHC) and alpha-tropomyosin (alpha-TM) genes. BACKGROUND:Mutation...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(98)00448-3
更新日期:1998-11-15 00:00:00
abstract:OBJECTIVES:We report the data from the Italian Survey on trans-septal catheterization (TSP-C) for catheter ablation of arrhythmias in the left heart that covered 2003 and previous years. BACKGROUND:Over the last decade the use of TSP-C in the electrophysiology laboratory has greatly increased. Recent data on number of...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jacc.2005.10.046
更新日期:2006-03-07 00:00:00
abstract::Ischemic heart disease is a complex disease process caused by the development of coronary atherosclerosis, with downstream effects on the left ventricular myocardium. It is characterized by a long preclinical phase, abrupt development of myocardial infarction, and more chronic disease states such as stable angina and ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2016.08.047
更新日期:2016-11-15 00:00:00
abstract::Members of the vascular endothelial growth factor (VEGF) family are among the most powerful modulators of vascular biology. They regulate vasculogenesis, angiogenesis, and vascular maintenance during embryogenesis and in adults. Because of their profound effects on blood vessels, VEGFs have received much attention reg...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2006.09.053
更新日期:2007-03-13 00:00:00
abstract:OBJECTIVES:This study was designed to evaluate the efficacy of local versus systemic treatment of thrombosis with various antithrombotic drugs. BACKGROUND:Local use of low dose antithrombotic drugs has been proposed as being effective and safe. METHODS:Heparin (30 U/kg), an antithrombin agent (argatroban, 0.05 mg/kg ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(95)00324-X
更新日期:1995-11-01 00:00:00
abstract::The temporal blood flow velocity profile in the descending aorta at the diaphragm was investigated using pulsed Doppler echocardiography in patients with documented coarctation of the aorta and in control patients. The ratio of peak systolic to peak diastolic frequency shift, an angle-independent index of pulsatility ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(86)80471-5
更新日期:1986-03-01 00:00:00
abstract:OBJECTIVES:We sought to evaluate the feasibility and validity of a new method to quantify the hyperemic response of the forearms that can be incorporated into a rest myocardial perfusion protocol. BACKGROUND:Evaluation of the hyperemic response could provide useful clinical information in the detection and risk strati...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2004.02.064
更新日期:2004-10-06 00:00:00
abstract:BACKGROUND:It is unclear whether the non-vitamin K antagonist oral anticoagulant agents rivaroxaban and dabigatran are superior to warfarin for efficacy and safety outcomes in Asians with nonvalvular atrial fibrillation (NVAF). OBJECTIVES:The aim of this study was to compare the risk for thromboembolic events, bleedin...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2016.06.062
更新日期:2016-09-27 00:00:00
abstract:OBJECTIVES:In a computed tomographic (CT) angiography study, we identified the characteristics of atherosclerotic lesions that were associated with subsequent development of acute coronary syndrome (ACS). BACKGROUND:The CT characteristics of culprit lesions in ACS include positive vessel remodeling (PR) and low-attenu...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2009.02.068
更新日期:2009-06-30 00:00:00
abstract:OBJECTIVES:This study was undertaken to determine the roles of serum fibrinogen and residual platelet reactivity after clopidogrel pre-treatment on ischemic events after elective percutaneous coronary intervention (PCI). BACKGROUND:Both elevated serum fibrinogen and high platelet reactivity with thienopyridines are as...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2012.09.037
更新日期:2013-01-08 00:00:00
abstract:OBJECTIVES:This study was designed to examine the relation between the timing and adequacy of perfusion of the infarct bed and changes in ventricular size and the extent of abnormal wall motion after acute myocardial infarction. METHODS:A validated echocardiographic mapping technique was used to measure the left ventr...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(93)90101-6
更新日期:1993-03-01 00:00:00
abstract:OBJECTIVES:We administered pilsicainide chloride, a class Ic pure sodium channel blocker, to patients with Brugada syndrome (BS) and evaluated the occurrence of ventricular arrhythmia (VA) and T-wave alternans (TWA). BACKGROUND:Ventricular arrhythmia and TWA are sometimes induced by a sodium channel blocker challenge ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2003.06.004
更新日期:2003-11-05 00:00:00
abstract:OBJECTIVES:We sought to examine the use, complications and outcomes with early intraaortic balloon counterpulsation (IABP) in patients presenting with cardiogenic shock complicating acute myocardial infarction and treated with thrombolytic therapy. BACKGROUND:The use of IABP in patients with cardiogenic shock is widel...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0735-1097(97)00227-1
更新日期:1997-09-01 00:00:00
abstract:BACKGROUND:Rates of referral to cardiac rehabilitation after percutaneous coronary intervention (PCI) have been historically low despite the evidence that rehabilitation is associated with lower mortality in PCI patients. OBJECTIVES:This study sought to determine the prevalence of and factors associated with referral ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jacc.2015.02.063
更新日期:2015-05-19 00:00:00
abstract:BACKGROUND:High systolic blood pressure (SBP) increases cardiac afterload, whereas low diastolic blood pressure (DBP) may lead to impaired coronary perfusion. Thus, wide pulse pressure (high systolic, low diastolic [HSLD]) may contribute to myocardial ischemia and also be a predictor of adverse cardiovascular events. ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2019.03.493
更新日期:2019-06-11 00:00:00
abstract::The opening of the tricuspid valve and the onset of right ventricular filling precede the opening of the mitral valve and the onset of flow in the normal adult. Sixty-five studies of atrioventricular flow with range-gated pulsed Doppler echocardiography, performed on 32 normal neonates, consistently demonstrated the r...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(88)80062-7
更新日期:1988-09-01 00:00:00
abstract:OBJECTIVES:We sought to evaluate the prognostic value of cardiac troponin I (cTnI) in asymptomatic, ambulatory patients with chronic renal failure treated with long-term hemodialysis. BACKGROUND:Smaller, short-term follow-up studies on this subject have given conflicting results. METHODS:A total of 126 ambulatory pat...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(01)01513-3
更新日期:2001-10-01 00:00:00
abstract:OBJECTIVES:The aim of our study was to evaluate arterial embolism (AE) occurrence rates and predictors in patients suffering from bradycardia and wearing a pacemaker with antitachycardia pacing therapies. BACKGROUND:Atrial fibrillation (AF) is associated with a high incidence of AE. METHODS:A total of 725 patients (3...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jacc.2005.07.044
更新日期:2005-11-15 00:00:00
abstract::Abnormalities in the fast Fourier transforms of signal-averaged electrocardiograms (ECGs) obtained during sinus rhythm appear to distinguish patients with ischemic heart disease and sustained monomorphic ventricular tachycardia from those without ventricular tachycardia. This study was performed to determine the power...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/0735-1097(90)90316-h
更新日期:1990-12-01 00:00:00
abstract:OBJECTIVES:This study was designed to elucidate the location and mechanism of typical atrial flutter in the transplanted heart. BACKGROUND:Although the F wave morphology in atrial flutter is similar in nontransplanted and transplanted hearts, the surgical incision needed for the atrial anastomosis may create a distinc...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(97)00186-1
更新日期:1997-08-01 00:00:00
abstract::To determine the reproducibility of two-dimensional exercise echocardiography, duplicate studies were performed on the same patients a median of 14 days apart. Because measurements are operator-dependent, interobserver variability was calculated for two experienced readers who interpreted the findings independently in...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(89)90467-1
更新日期:1989-10-01 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 (...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2019.12.066
更新日期:2020-03-17 00:00:00