Hospital patterns of medical management strategy use for patients with non-ST-elevation myocardial infarction and 3-vessel or left main coronary artery disease.


BACKGROUND:Patients with non-ST-elevation myocardial infarction (NSTEMI) and three-vessel or left main coronary disease (3VD/LMD) have a high risk of long-term mortality when treated with a medical management strategy (MMS) compared with revascularization. METHODS:We evaluated patterns of use and patient features across United States hospitals designated by MMS for NSTEMI patients with 3VD/LMD included in the ACTION Registry-GWTG from 2007-2012. RESULTS:A total of 42,535 patients without prior bypass surgery were found to have 3VD (≥50% stenosis in all major coronary vessels) or LMD (≥50% lesion) during in-hospital angiography at 423 hospitals with percutaneous and surgical revascularization capabilities. Hospitals (n = 316) with an adequate volume (≥25 NSTEMI patients treated) were stratified into tertiles defined by use of MMS; differences in patient characteristics and outcomes were analyzed. The proportion of NSTEMI patients treated with MMS at all hospitals varied from 16% to 19% each quarter and did not change significantly from 2007 to 2012 (P trend = .11). Among hospitals with adequate volume, the proportion of patients treated with MMS also varied widely (median 17.1%, range: 0.0-44.8%, P < .0001). Patient baseline characteristics, predicted mortality risk, actual in-hospital mortality rates, and discharge treatments were similar across hospital tertiles. CONCLUSIONS:Close to 20% of patients with NSTEMI and 3VD/LMD identified during in-hospital angiography are treated with MMS without revascularization in contemporary practice. Since the use of MMS varies widely across hospitals despite a relatively similar hospital-level case mix, these findings suggest that there is no standard threshold for the use of revascularization in NSTEMI patients with 3VD/LMD.


Am Heart J


American heart journal


Harskamp RE,Wang TY,Bhatt DL,Wiviott SD,Amsterdam EA,Li S,Thomas L,de Winter RJ,Roe MT




Has Abstract


2014-03-01 00:00:00














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    abstract::Variation in measurements made from signal-averaged electrocardiograms was examined. Averaging 200 beats in 18 normal subjects, pairs of high-frequency QRS and low-amplitude signal durations correlated at immediate, short-term, and long-term intervals. The percent high-frequency (60 Hz to 120 Hz) voltages in the late ...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Engel TR,Pierce DL,Patil KD

    更新日期:1991-12-01 00:00:00

  • Quinidine therapy in hospitalized patients with ventricular arrhythmias.

    abstract::Quinidine serum levels and pharmacokinetic data were assessed during steady state therapy with oral quinidine sulfate in 19 hospitalized patients who were being treated for ventricular arrhythmias. A new high performance liquid chromatography assay was employed. Four patients were studied both after the first dose of ...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Carliner NH,Crouthamel WG,Fisher ML,Mugmon MA,Vassar DL,Narang PK,Plotnick GD

    更新日期:1979-12-01 00:00:00

  • Reproducibility of the proximal flow convergence method in mitral and tricuspid regurgitation.

    abstract:BACKGROUND:The follow-up of patients with mitral and tricuspid regurgitation is important for their clinical treatment. We aimed to evaluate the reproducibility of the flow convergence method in mitral and tricuspid regurgitation. METHODS:The proximal flow convergence region was imaged with color Doppler ultrasound sc...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Grossmann G,Hoffmeister A,Imhof A,Giesler M,Hombach V,Spiess J

    更新日期:2004-04-01 00:00:00

  • Drug-eluting stents for the treatment of bifurcation lesions: a randomized comparison between paclitaxel and sirolimus stents.

    abstract:BACKGROUND:Drug-eluting stents have been shown to reduce restenosis in many types of lesions. The purpose of this article is to assess the efficacy of sirolimus- and paclitaxel-eluting stents in patients with bifurcation lesions. METHODS:Between June 2003 and October 2004, 205 patients were enrolled in a prospective r...

    journal_title:American heart journal

    pub_type: 杂志文章,随机对照试验


    authors: Pan M,Suárez de Lezo J,Medina A,Romero M,Delgado A,Segura J,Ojeda S,Mazuelos F,Hernandez E,Melian F,Pavlovic D,Esteban F,Herrador J

    更新日期:2007-01-01 00:00:00

  • Troponin T is a better predictor than creatine kinase-MB of long-term mortality after coronary artery bypass graft surgery.

    abstract:BACKGROUND:Elevations of creatine kinase-MB (CK-MB) and cardiac troponin T (cTnT) have an uncertain long-term prognostic value after coronary artery bypass graft (CABG) surgery. We aimed to test the hypothesis that CK-MB and cTnT are predictors of long-term survival after CABG and to assess which of these 2 biomarkers ...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Søraas CL,Friis C,Engebretsen KV,Sandvik L,Kjeldsen SE,Tønnessen T

    更新日期:2012-11-01 00:00:00

  • Dobutamine and nitroprusside infusion in patients with severe congestive heart failure: hemodynamic improvement by discordant effects on mitral regurgitation, left atrial function, and ventricular function.

    abstract:OBJECTIVES:In patients with severe heart failure additional therapeutic support with intravenous inotropic or vasodilator drugs is frequently used in the attempt to obtain hemodynamic control. The nature and extent to which diastolic filling, atrial function, and mitral regurgitation are modified by these drugs have no...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Capomolla S,Pozzoli M,Opasich C,Febo O,Riccardi G,Salvucci F,Maestri R,Sisti M,Cobelli F,Tavazzi L

    更新日期:1997-12-01 00:00:00

  • Primary prevention in patients with hypertension: comments on the clinical implications of the MAPHY Study. Metoprolol Atherosclerosis Prevention in Hypertensives Study.

    abstract::The MAPHY Study was conducted to investigate whether metoprolol, a relatively beta 1-selective beta-blocker, given as initial antihypertensive treatment, would lower cardiovascular complications of high blood pressure to a greater extent than do thiazide diuretics as initial treatment at similar blood pressure control...

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    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Wikstrand J

    更新日期:1988-07-01 00:00:00

  • Effect of lesion length on fractional flow reserve in intermediate coronary lesions.

    abstract:BACKGROUND:Fractional flow reserve (FFR) has become a gold standard in physiological assessment of coronary artery stenosis. An FFR < 0.75 is considered as a reliable physiological parameter indicating functionally significant lesion. Lesion length (LL) may affect the translesional hemodynamics. However, the effect of ...

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    pub_type: 杂志文章


    authors: Brosh D,Higano ST,Lennon RJ,Holmes DR Jr,Lerman A

    更新日期:2005-08-01 00:00:00

  • Comparison of the hypolipidemic effect of gemfibrozil versus simvastatin in patients with type III hyperlipoproteinemia.

    abstract:BACKGROUND:Type III hyperlipoproteinemia is characterized by the accumulation of chylomicron and very low density lipoprotein (VLDL) remnants. Individuals with this disorder have a high risk of premature atherosclerosis, and hypolipidemic drugs are useful in their management. METHODS:We compared, in a double-blind, pl...

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    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Civeira F,Cenarro A,Ferrando J,Puzo J,Garcia-Otín AL,Mozas P,Pocoví M

    更新日期:1999-07-01 00:00:00

  • Application of noninvasive techniques for measuring cardiac output in hypertensive patients.

    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


    authors: Franciosa JA

    更新日期:1988-08-01 00:00:00

  • Relation between collateral flow assessed by Doppler guide wire and angiographic collateral grades.

    abstract::We investigated the relation between the angiographic collateral grade (Rentrop's classification) and the collateral flow velocity pattern in 43 patients with angina pectoris. Collateral flow velocity was measured with a Doppler guide wire during balloon occlusion in coronary angioplasty. Collateral flow was detected ...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Yamada T,Okamoto M,Sueda T,Hashimoto M,Kajiyama G

    更新日期:1995-07-01 00:00:00

  • Income level and inequality as complement to geographical differences in cardiovascular trials.

    abstract:BACKGROUND:Analyses of country or regional differences in cardiovascular (CV) trials are based on geographical subgroup analyses. However, apart from map location and related racial, ethnic, and genetic variations, identified differences may also depend on social structure and provision and access to health care, for w...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Ferreira JP,Rossignol P,Dewan P,Lamiral Z,White WB,Pitt B,McMurray JJV,Zannad F

    更新日期:2019-12-01 00:00:00

  • Cardiopulmonary exercise testing in syndrome X.

    abstract::Patients with syndrome X have been found to have an abnormal coronary blood flow reserve. The physical performance during exercise, however, has been incompletely investigated. Cardiopulmonary exercise testing (CPX) is a reliable noninvasive method to provide indexes of lung, heart, circulation, and muscle functions. ...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Montorsi P,Agostoni PG,Annoni L,Vincenzi P,Guazzi MD

    更新日期:1993-03-01 00:00:00

  • Prevention of nitroglycerin tolerance with diuretics.

    abstract::Tolerance to prolonged nitroglycerin (NTG) may be due to drug-induced intravascular expansion. To test the hypothesis that concomitant diuretics may reduce volume expansions and thus prevent NTG tolerance, we studied 23 healthy volunteers randomized to hydrochlorthiazide or placebo before and during 74-hour continuous...

    journal_title:American heart journal

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Mohanty N,Wasserman AG,Walker P,Katz RJ

    更新日期:1995-09-01 00:00:00

  • National patterns in intensity and frequency of outpatient care for apparent treatment-resistant hypertension.

    abstract:BACKGROUND:Apparent treatment-resistant hypertension (aTRH) is associated with an increased risk of adverse cardiovascular outcomes. We studied the frequency and intensity of care for aTRH among participants aged 65 years and older in the US-based REGARDS study linked with Medicare claims. METHODS:Blood pressure (BP) ...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Vemulapalli S,Deng L,Patel MR,Kilgore ML,Jones WS,Curtis LH,Irvin MR,Svetkey LP,Shimbo D,Calhoun DA,Muntner P

    更新日期:2017-04-01 00:00:00

  • Recovery kinetics of oxygen uptake is prolonged in adults with an atrial septal defect and improves after transcatheter closure.

    abstract:BACKGROUND:In adults with an atrial septal defect (ASD) transcatheter closure leads to an improvement of peak oxygen uptake (VO2), but the kinetics of recovery of VO2 after maximal exercise in this patient population and the impact of transcatheter ASD closure have never been investigated. METHODS:Twenty consecutive p...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Giardini A,Donti A,Specchia S,Coutsoumbas G,Formigari R,Prandstraller D,Bronzetti G,Bonvicini M,Picchio FM

    更新日期:2004-05-01 00:00:00

  • Vasodilatation with felodipine in chronic asymptomatic aortic regurgitation.

    abstract:BACKGROUND:Afterload reduction decreases volume overload on the left ventricle and may thereby delay the need for valve replacement in chronic asymptomatic aortic regurgitation. The aims of this randomized double-blind, placebo-controlled trial were to examine short- and long-term hemodynamic effects of felodipine in c...

    journal_title:American heart journal

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Søndergaard L,Aldershvile J,Hildebrandt P,Kelbaek H,Ståhlberg F,Thomsen C

    更新日期:2000-04-01 00:00:00

  • Clofibrate effects: mitochondria vs exercise tolerance in aging hamsters.

    abstract::Mitochondria in skeletal and cardiac muscle have been found to be less stable in aging hamsters, in contrast to preparations from young animals. We have found previously that clofibrate (Atromid-S) will reverse this degeneration in the older hamsters. This study examined the exercise tolerance of aged hamsters, to see...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Guntheroth WG,Inamdar AR,Person R,Mackler B

    更新日期:1977-10-01 00:00:00

  • Cigarette smoking exposure and heart failure risk in older adults: the Health, Aging, and Body Composition Study.

    abstract:BACKGROUND:Although there is evidence linking smoking and heart failure (HF), the association between lifetime smoking exposure and HF in older adults and the strength of this association among current and past smokers is not well known. METHODS:We examined the association between smoking status, pack-years of exposur...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Gopal DM,Kalogeropoulos AP,Georgiopoulou VV,Smith AL,Bauer DC,Newman AB,Kim L,Bibbins-Domingo K,Tindle H,Harris TB,Tang WW,Kritchevsky SB,Butler J

    更新日期:2012-08-01 00:00:00

  • Report of the National Heart, Lung and Blood Institute-National Institute of Allergy and Infectious Diseases working group on antimicrobial strategies and cardiothoracic surgery.

    abstract::Infections related to cardiac surgery increase morbidity and mortality, and increase cost and use of health resources. With the widespread use of synthetic materials, whether in prosthetic valves or vascular conduits, bacterial infection and, more rarely, fungal complications can be devastating, requiring prolonged an...

    journal_title:American heart journal

    pub_type: 评论


    authors: Lowy FD,Waldhausen JA,Miller M,Sopko G,Rosenberg Y,Skarlatos SI,National Heart, Lung and Blood Institute-National Institute of Allergy and Infectious Diseases working group on antimicrobial strategies and cardiothoracic surgery.

    更新日期:2004-04-01 00:00:00

  • Dilatation of the left ventricular cavity on dipyridamole thallium-201 imaging: a new marker of triple-vessel disease.

    abstract::To investigate the significance and mechanism of dilatation of the left ventricular cavity on dipyridamole thallium-201 imaging, we performed both dipyridamole thallium-201 imaging and dipyridamole radionuclide angiography on 83 patients with known angiograms. The dipyridamole/delayed ratio of the left ventricular dim...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Takeishi Y,Tono-oka I,Ikeda K,Komatani A,Tsuiki K,Yasui S

    更新日期:1991-02-01 00:00:00

  • Disparities in myocardial infarction case fatality rates among the elderly: the 20-year Medicare experience.

    abstract:BACKGROUND:Case fatality rates after acute myocardial infarction (MI) have decreased markedly over the last 3 decades. Some subgroups may have benefited more than others, but this hypothesis has not been evaluated in a large nationally representative cohort. Accordingly, we sought to assess long-term temporal trends in...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Wellenius GA,Mittleman MA

    更新日期:2008-09-01 00:00:00

  • Myocardial reperfusion injury in the canine model after 40 minutes of ischemia: effect of intracoronary adenosine.

    abstract::To explore the contribution of reperfusion injury to final infarct size after a short duration of ischemia, closed-chest dogs underwent 40 minutes of proximal left anterior descending artery occlusion followed by 3 days of reperfusion. Animals randomly received intracoronary adenosine (n = 8) at 3.75 mg/min during the...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Velasco CE,Turner M,Cobb MA,Virmani R,Forman MB

    更新日期:1991-12-01 00:00:00

  • Shortcomings of the Lown grading system for observational or experimental studies in ischemic heart disease.

    abstract::The Lown grading system uses three levels of frequency and four complex features to grade ventricular arrhythmias. The seven Lown grades are mutually exclusive (a patient can be in only one grade) and hierarchical (higher grades indicate increased likelihood of death). We evaluated the ability of the Lown arrhythmia g...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Bigger JT Jr,Weld FM

    更新日期:1980-12-01 00:00:00

  • Transient appearance of collaterals during vasospastic occlusion in patients without obstructive coronary atherosclerosis.

    abstract::Coronary angiography of both right and left coronary arteries, using the Sones technique, was performed during the attack of total spastic obstruction in 11 patients with clinically documented history of variant angina. None of the patients had more than 70% stenosis of organic atherosclerosis in any coronary artery a...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Matsuda Y,Ogawa H,Moritani K,Matsuda M,Katayama K,Fujii T,Kohno M,Miura T,Kohtoku S,Kusukawa R

    更新日期:1985-04-01 00:00:00

  • Influence of gravity on pulmonary venous flow velocity patterns: analysis of left and right pulmonary venous flow velocities in left and right decubitus positions.

    abstract:BACKGROUND:The pulmonary venous flow signal measured by transesophageal echocardiography is generally recorded from the left upper pulmonary vein in the left lateral decubitus position, whereas that by transthoracic echocardiography is from the right upper pulmonary vein in the left semi-lateral decubitus position. The...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Izumi C,Iga K,Himura Y,Gen H,Konishi T

    更新日期:1999-03-01 00:00:00

  • Characterization of chronically implanted ventricular endocardial pacing leads.

    abstract::The expected implant lifetime of pacemaker generators has been extended with the introduction of lithium power sources. Consequently, the pacing lead may become the component that determines the total implant lifetime of the pacemaker. This fact emphasizes the necessity for accurate assessment of the integrity of a ch...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Angello DA,McAnulty JH,Dobbs J

    更新日期:1984-06-01 00:00:00

  • Development and validation of a risk model for in-hospital worsening heart failure from the Acute Decompensated Heart Failure National Registry (ADHERE).

    abstract:BACKGROUND:A subset of patients hospitalized with acute heart failure experiences in-hospital worsening heart failure, defined as persistent or worsening signs or symptoms requiring an escalation of therapy. METHODS:We analyzed data from the Acute Decompensated Heart Failure National Registry (ADHERE) linked to Medica...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: DeVore AD,Greiner MA,Sharma PP,Qualls LG,Schulte PJ,Cooper LB,Mentz RJ,Pang PS,Fonarow GC,Curtis LH,Hernandez AF

    更新日期:2016-08-01 00:00:00

  • Sinus node recovery times following the spontaneous termination of supraventricular tachycardia and following atrial overdrive pacing: a comparison.

    abstract::We compared the pauses that followed the spontaneous termination of supraventricular tachyarrhythmias with the pauses that followed the cessation of atrial overdrive pacing in 21 patients. In 10 patients with abnormal sinus node function and in 11 patients with normal sinus node function we recorded the spontaneous te...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Gang ES,Reiffel JA,Livelli FD Jr,Bigger JT Jr

    更新日期:1983-02-01 00:00:00

  • Repeat stenting for the prevention of the early lumen loss phenomenon in patients with in-stent restenosis. Angiographic and intravascular ultrasound findings of a randomized study.

    abstract:BACKGROUND:Early lumen loss (ELL) may be detected in patients undergoing coronary interventions for in-stent restenosis. This phenomenon may contribute to recurrences. This prospective, randomized study was designed to determine if repeat stent implantation may prevent ELL in patients with in-stent restenosis. METHODS...

    journal_title:American heart journal

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Alfonso F,García P,Fleites H,Pimentel G,Sabaté M,Hernández R,Escaned J,Bañuelos C,Pérez-Vizcayno MJ,Moreno R,Macaya C

    更新日期:2005-02-01 00:00:00