Abstract:
:To assess the likelihood of procedural success in patients with multivessel coronary disease undergoing percutaneous coronary angioplasty, 350 consecutive patients (1,100 stenoses) from four clinical sites were evaluated. Eighteen variables characterizing the severity and morphology of each stenosis and 18 patient-related variables were assessed at a core angiographic laboratory and at the clinical sites. Most patients had Canadian Cardiovascular Society class III or IV angina (72%) and two-vessel coronary disease (78%). Left ventricular function was generally well preserved (mean ejection fraction, 58 +/- 12%; range, 18-85%) and 1.9 +/- 1.0 stenoses per patient had attempted percutaneous coronary angioplasty. Procedural success (less than or equal to 50% final diameter stenosis in one or more stenoses and no major ischemic complications) was achieved in 290 patients (82.8%), and an additional nine patients (2.6%) had a reduction in diameter stenosis by 20% or more with a final diameter stenosis 51-60% and were without major complications. Major ischemic complications (death, myocardial infarction, or emergency bypass surgery) occurred in 30 patients (8.6%). In-hospital mortality was 1.1%. Stepwise regression analysis determined that a modified American College of Cardiology/American Heart Association Task Force (ACC/AHA) classification of the primary target stenosis (with type B prospectively divided into type B1 [one type B characteristic] and type B2 [greater than or equal to two type B characteristics]) and the presence of diabetes mellitus were the only variables independently predictive of procedural outcome (target stenosis modified ACC/AHA score; p less than 0.001 for both success and complications; diabetes mellitus: p = 0.003 for success and p = 0.016 for complications). Analysis of success and complications on a per stenosis dilated basis showed, for type A stenoses, a 92% success and a 2% complication rate; for type B1 stenoses, an 84% success and a 4% complication rate; for type B2 stenoses, a 76% success and a 10% complication rate; and for type C stenoses, a 61% success and a 21% complication rate. The subdivision into types B1 and B2 provided significantly more information in this clinically important intermediate risk group than did the standard ACC/AHA scheme. The stenosis characteristics of chronic total occlusion, high grade (80-99% diameter) stenosis, stenosis bend of more than 60 degrees, and excessive tortuosity were particularly predictive of adverse procedural outcome. This improved scheme may improve clinical decision making and provide a framework on which to base meaningful subgroup analysis in randomized trials assessing the efficacy of percutaneous coronary angioplasty.
journal_name
Circulationjournal_title
Circulationauthors
Ellis SG,Vandormael MG,Cowley MJ,DiSciascio G,Deligonul U,Topol EJ,Bulle TMdoi
10.1161/01.cir.82.4.1193subject
Has Abstractpub_date
1990-10-01 00:00:00pages
1193-202issue
4eissn
0009-7322issn
1524-4539journal_volume
82pub_type
杂志文章相关文献
CIRCULATION文献大全abstract::To examine whether or not magnesium suppresses coronary spasm, the effect of magnesium infusion on anginal attacks induced by hyperventilation was studied in 20 patients with variant angina. In all patients, anginal attacks associated with ischemic ST segment changes on the electrocardiogram were repeatedly induced by...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.79.3.597
更新日期:1989-03-01 00:00:00
abstract:BACKGROUND:Endocardial mapping using standard electrode catheters is often technically limited in ventricular tachycardia and constitutes a major obstacle to successful ablation. We wished to examine the utility of a basket-shaped multielectrode mapping catheter (MMC) in the mapping and ablation of ventricular tachycar...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.96.7.2430
更新日期:1997-10-07 00:00:00
abstract:BACKGROUND:The role of endothelial nitric oxide synthase (eNOS) in ischemic preconditioning (PC) and cardioprotection is poorly understood. We addressed this issue using a genetic, rather than pharmacological, approach. METHODS AND RESULTS:In the nonpreconditioned state, eNOS-/- mice exhibited infarct sizes similar to...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.107.689471
更新日期:2007-07-31 00:00:00
abstract:BACKGROUND:Serum bilirubin is an endogenous antioxidant that is routinely measured before a statin is prescribed primarily to assess liver function, but the association with cardiovascular disease (CVD) in this population has not been explored. METHOD AND RESULTS:We identified patients from a United Kingdom primary ca...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.112.114066
更新日期:2012-11-27 00:00:00
abstract:BACKGROUND:Peripheral arterial disease (PAD) is associated with significant morbidity and mortality and is an important marker of subclinical coronary heart disease. However, estimates of PAD prevalence in the general US population have varied widely. METHODS AND RESULTS:We analyzed data from 2174 participants aged 40...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000137913.26087.F0
更新日期:2004-08-10 00:00:00
abstract:BACKGROUND:Functional mitral regurgitation (MR) is caused by systolic traction on the mitral leaflets related to ventricular distortion. Little is known about whether chronic tethering causes the mitral leaflet area to adapt to the geometric needs imposed by tethering, in part because of inability to reconstruct leafle...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.107.749440
更新日期:2008-08-19 00:00:00
abstract:BACKGROUND:The incidence of pulmonary arterial hypertension secondary to the use of indirect serotinergic agonists such as aminorex and dexfenfluramine led to the "serotonin hypothesis" of pulmonary arterial hypertension; however, the role of serotonin in dexfenfluramine-induced pulmonary arterial hypertension remains ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.108.767558
更新日期:2008-06-03 00:00:00
abstract:BACKGROUND:Poststroke angiogenesis contributes to long-term recovery after stroke. Signal transducer and activator of transcription-3 (Stat3) is a key regulator for various inflammatory signals and angiogenesis. It was the aim of this study to determine its function in poststroke outcome. METHODS AND RESULTS:We genera...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.114.013003
更新日期:2015-05-19 00:00:00
abstract:BACKGROUND:Platelet-thrombus formation is a complication of arterial wall deep injury by balloon angioplasty that may lead to acute arterial occlusion and may contribute to restenosis. METHODS AND RESULTS:Because common platelet-inhibitor drugs with a heparin bolus (100 units/kg) may be effective in inhibiting platele...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.84.2.814
更新日期:1991-08-01 00:00:00
abstract:BACKGROUND:Keratinocyte growth factor (KGF) has been shown to play an important role in pneumocyte proliferation and lung development. We hypothesized that exogenous KGF would enhance postpneumonectomy compensatory lung growth through alveolar proliferation. METHODS AND RESULTS:Adult Sprague-Dawley rats were used. Lef...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:2002-09-24 00:00:00
abstract::The Academic Research Consortium (ARC)-2 initiative revisited the clinical and angiographic end point definitions in coronary device trials, proposed in 2007, to make them more suitable for use in clinical trials that include increasingly complex lesion and patient populations and incorporate novel devices such as bio...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/CIRCULATIONAHA.117.029289
更新日期:2018-06-12 00:00:00
abstract:BACKGROUND:In patients with heart failure, excessive sympathetic activation during exercise could interfere with exercise performance by impairing arteriolar dilation in working muscle and by adversely altering skeletal muscle metabolic behavior. To test this hypothesis, we examined the effect of sympathoinhibition wit...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.96.1.238
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:Few published data describe long-term survival of dialysis patients undergoing surgical versus percutaneous coronary revascularization in the era of drug-eluting stents (DES). METHODS AND RESULTS:Using United States Renal Data System data, we identified 23 033 dialysis patients who underwent coronary revasc...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.112.001264
更新日期:2013-05-07 00:00:00
abstract:BACKGROUND:Endocarditis related to pacemaker (PM)-lead infection is a rare but serious complication of permanent transvenous pacing. To determine in which situations the diagnosis should be evoked and to determine optimal management, we reviewed our experience with endocarditis related to PM-lead infection. METHODS AN...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/01.cir.95.8.2098
更新日期:1997-04-15 00:00:00
abstract:BACKGROUND:In large mammals and humans, the contribution of IKs to ventricular repolarization is still incompletely understood. METHODS AND RESULTS:In vivo and cellular electrophysiological experiments were conducted to study IKs in canine ventricular repolarization. In conscious dogs, administration of the selective ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000068344.54010.B3
更新日期:2003-06-03 00:00:00
abstract:BACKGROUND:Interferons (IFNs) play an important role in antiviral defense and have therapeutic potential in coxsackievirus heart disease. However, little is known about the relative contributions of type I and type II IFN signaling in coxsackievirus B3 (CVB3) infection or their role in the cardioselective nature of CVB...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.103.5.756
更新日期:2001-02-06 00:00:00
abstract:BACKGROUND:Traditional risk factors have been linked to atherosclerotic heart disease in women. However, the effect of risk factors and menopausal status on the mechanism of sudden coronary death is unknown. METHODS AND RESULTS:We examined 51 cases of sudden coronary death and 15 hearts from women who died of trauma. ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.97.21.2110
更新日期:1998-06-02 00:00:00
abstract::Integrated ultrasonic backscatter (IB) is a noninvasive measure of the acoustic properties of myocardium. Previous experimental studies have indicated that altered acoustic properties of the myocardium are reflected by the magnitude of variation of IB during the cardiac cycle. In our study, cardiac cycle-dependent var...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.80.4.925
更新日期:1989-10-01 00:00:00
abstract::Although past reports have identified a variety of prognostic factors in patients with severe chronic heart failure, previous studies have not evaluated the interaction of prognostic variables and drug treatment. We analyzed the association of 30 clinical, hemodynamic, and biochemical variables with survival in 203 co...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.73.2.257
更新日期:1986-02-01 00:00:00
abstract:BACKGROUND:Radiofrequency catheter ablation of concealed posteroseptal accessory pathways (APS) has been a relatively difficult task for electrophysiologists. Without a detailed mapping procedure, the left versus the right posteroseptal AP could not be distinguished. We investigated the electrophysiological characteris...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.93.5.982
更新日期:1996-03-01 00:00:00
abstract::Little is known of the functional capacity of coronary collaterals in humans without occlusive coronary artery disease. We, therefore, measured peripheral coronary pressure (PCP) and retrograde flow (RF) from coronary arteries at aortic valve replacement in seven patients without occlusive coronary artery disease. Usi...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.51.1.118
更新日期:1975-01-01 00:00:00
abstract:BACKGROUND:We have previously shown major differences in beta-adrenergic and muscarinic modulation of L-type calcium currents (ICa) in newborn and adult rabbit heart. However, little is known about developmental changes in modulation of ICa by phosphodiesterases (PDEs), which also regulate intracellular cAMP concentrat...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.90.1.469
更新日期:1994-07-01 00:00:00
abstract:BACKGROUND:Outcomes after percutaneous coronary interventions in diabetic patients are shadowed by the increased rate of recurrence compared with nondiabetic patients. METHODS AND RESULTS:We conducted a multicenter, randomized trial to demonstrate the efficacy of sirolimus-eluting stents compared with standard stents ...
journal_title:Circulation
pub_type: 杂志文章,随机对照试验
doi:10.1161/CIRCULATIONAHA.105.562421
更新日期:2005-10-04 00:00:00
abstract:BACKGROUND:Angiogenesis is a critical feature of plaque development in atherosclerosis and might play a key role in both the initiation and later rupture of plaques that lead to myocardial infarction and stroke. The precursory molecular or cellular events that initiate plaque growth and that ultimately contribute to pl...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000093185.16083.95
更新日期:2003-11-04 00:00:00
abstract::Analysis of the external brachial pulse recorded during standard blood pressure cuff deflation with use of a transducer with a wide frequency response has revealed a reproducible pattern with three distinct components that we have labeled K1, K2, and K3. K1 is a low-amplitude, low-frequency signal that is present with...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.77.6.1297
更新日期:1988-06-01 00:00:00
abstract:BACKGROUND:The incidence and cause of sudden cardiac death (SCD) in athletes is debated with hypertrophic cardiomyopathy often reported as the most common cause. METHODS AND RESULTS:A database of all National Collegiate Athletic Association deaths (2003-2013) was developed. Additional information and autopsy reports w...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/CIRCULATIONAHA.115.015431
更新日期:2015-07-07 00:00:00
abstract::We assessed the reversibility of functional and morphological changes of arterialized vein segments by returning them to the venous circulation. Thirteen dogs underwent right carotid and femoral veno-arterial grafting. After 12 weeks, veno-arterial grafts were removed for contractility (norepinephrine [NE] and 5-hydro...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1990-11-01 00:00:00
abstract:BACKGROUND:Ventricular septal defect (VSD) complicating acute myocardial infarction has been studied primarily in small, prethrombolytic-era trials. Our goal was to determine clinical predictors and angiographic and clinical outcomes of this complication in the thrombolytic era. METHODS AND RESULTS:We compared enrollm...
journal_title:Circulation
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1161/01.cir.101.1.27
更新日期:2000-01-04 00:00:00
abstract::Between July 1985 and September 1987, 25 patients underwent 26 carotid endarterectomies based on an abnormal duplex scan (B-mode ultrasonography and pulsed-Doppler sound spectral analysis) indicative of severe stenosis or ulceration. Arteriography was not performed because of severe unstable angina requiring coronary ...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1988-09-01 00:00:00
abstract:BACKGROUND:During the initial phase of an ischemic insult, left ventricular (LV) performance depends on the complex interaction between oxygen deprivation, vascular turgor, and accumulation of metabolites. In experimental preparations, low-flow ischemia decreases systolic shortening and increases diastolic LV distensib...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.88.2.461
更新日期:1993-08-01 00:00:00