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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    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Mortara A,La Rovere MT,Pinna GD,Parziale P,Maestri R,Capomolla S,Opasich C,Cobelli F,Tavazzi L

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    abstract:BACKGROUND:The prevalence of renal disease in cardiac intensive care units (CICUs) is increasing, but little is known about the utilization, concurrent therapies, and outcomes of patients requiring acute renal replacement therapy (RRT) in this specialized environment. METHODS:In the Critical Care Cardiology Trials Net...

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    pub_type: 杂志文章,多中心研究


    authors: van Diepen S,Tymchak W,Bohula EA,Park JG,Daniels LB,Phreaner N,Barnett CF,Kenigsberg BB,DeFilippis A,Singam NS,Barsness GW,Jentzer JC,Ternus B,Morrow DA,Katz JN,Critical Care Cardiology Trials Network Investigators.

    更新日期:2020-04-01 00:00:00

  • Genetic loci associated with ideal cardiovascular health: A meta-analysis of genome-wide association studies.

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    journal_title:American heart journal

    pub_type: 杂志文章,meta分析


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    更新日期:2016-05-01 00:00:00

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    abstract:BACKGROUND:Previous studies reported an impairment of nervous autonomic activity in patients with Duchenne muscular dystrophy (DMD). However, the relationship of the autonomic dysfunction to the impairment of cardiac mechanical function and of respiratory failure is not completely understood. METHODS:We evaluated card...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Lanza GA,Dello Russo A,Giglio V,De Luca L,Messano L,Santini C,Ricci E,Damiani A,Fumagalli G,De Martino G,Mangiola F,Bellocci F

    更新日期:2001-05-01 00:00:00

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    abstract::Automatic external defibrillators (AEDs) represent an important technologic innovation in the management of out-of-hospital cardiac arrest. We propose the following concept: AEDs are machines with the limited task of ventricular fibrillation (VF) identification, countershock delivery, and defibrillation. They cannot b...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Cummins RO,Eisenberg MS,Hallstrom AP,Hearne TR,Graves JR,Litwin PE

    更新日期:1985-12-01 00:00:00

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    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Missov E,Mair J

    更新日期:1999-07-01 00:00:00

  • Effects of ryanodine on cat papillary muscle and isolated rat heart.

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    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Blumlein SL,Sievers R,Wikman-Coffelt J,Parmley WW,Rouleau JL

    更新日期:1985-08-01 00:00:00

  • Effect of low doses of n-3 fatty acids on cardiovascular diseases in 4,837 post-myocardial infarction patients: design and baseline characteristics of the Alpha Omega Trial.

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    journal_title:American heart journal

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Geleijnse JM,Giltay EJ,Schouten EG,de Goede J,Oude Griep LM,Teitsma-Jansen AM,Katan MB,Kromhout D,Alpha Omega Trial Group.

    更新日期:2010-04-01 00:00:00

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    abstract:BACKGROUND:Exercise training is now an accepted component of the therapeutic regimen in patients with heart failure and underlying ischemia, but few data are available on the effects of training in patients with nonischemic dilated cardiomyopathy. METHODS:Twenty-four patients (mean age 55 +/- 9 years, mean ejection fr...

    journal_title:American heart journal

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Myers J,Wagner D,Schertler T,Beer M,Luchinger R,Klein M,Rickli H,Muller P,Mayer K,Schwitter J,Dubach P

    更新日期:2002-10-01 00:00:00

  • Pretreatment plasminogen activator inhibitor-1 (PAI-1) levels and the outcome of thrombolysis with streptokinase in patients with acute myocardial infarction.

    abstract:BACKGROUND:The risk for reinfarctions and delays in reperfusion after streptokinase therapy may be caused by the antifibrinolytic effect of platelet-derived type 1 plasminogen activator inhibitor (PAI-1). This study aims to show the relation of pretreatment PAI-1 levels of patients with acute myocardial infarction trea...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Sinkovic A

    更新日期:1998-09-01 00:00:00

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    pub_type: 杂志文章,随机对照试验


    authors: Mehilli J,Neumann FJ,Ndrepepa G,King L,Schulz S,Maimer Rodrigues da Cunha F,Jochheim D,Byrne RA,Hausleiter J,Ott I,Massberg S,Kastrati A,Pache J

    更新日期:2013-04-01 00:00:00

  • Myocardial infarction in the newborn: a case report complicated by cardiogenic shock and associated with normal coronary arteries.

    abstract::Fatal myocardial infarction occurring in a neonate is reported. The patient presented with a clinical picture of cardiogenic shock simulating a hypoplastic left heart syndrome. Etiology of the myocardial infarction is uncertain for the coronary arteries were patent, anatomically and histologically normal, and there wa...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Iannone LA,Duritz G,McCarty RJ

    更新日期:1975-02-01 00:00:00

  • Impact of contrast-induced acute kidney injury definition on clinical outcomes.

    abstract:BACKGROUND:Contrast-induced acute kidney injury (CIAKI) is a frequent complication after infusion of contrast media in patients undergoing percutaneous coronary intervention. A wide range of CIAKI rates occurs after intervention between 3% and 30%, depending on the definition. The aim of this study was to identify whic...

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    pub_type: 杂志文章


    authors: Budano C,Levis M,D'Amico M,Usmiani T,Fava A,Sbarra P,Burdese M,Segoloni GP,Colombo A,Marra S

    更新日期:2011-05-01 00:00:00

  • Circadian variation and triggering of acute coronary events.

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    pub_type: 杂志文章,评审


    authors: Muller JE

    更新日期:1999-04-01 00:00:00

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    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Lewis SJ,Sawada SG,Ryan T,Segar DS,Armstrong WF,Feigenbaum H

    更新日期:1991-04-01 00:00:00

  • Novel predictor of prognosis from exercise stress testing: heart rate variability response to the exercise treadmill test.

    abstract:BACKGROUND:Although the prognostic power of heart rate variability (HRV) at rest has been demonstrated, the prognostic potential of exercise-induced HRV has not been investigated. We aimed to evaluate the prognostic power of exercise-induced HRV during and after standard exercise testing. METHODS:Time- and frequency-d...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Dewey FE,Freeman JV,Engel G,Oviedo R,Abrol N,Ahmed N,Myers J,Froelicher VF

    更新日期:2007-02-01 00:00:00

  • Clopidogrel use and clinical events after drug-eluting stent implantation: findings from the HealthCore Integrated Research Database.

    abstract:BACKGROUND:Relationships between long-term use and level of dual antiplatelet therapy and outcomes after drug-eluting stent implantation are not well established. METHODS:This is a retrospective cohort study of 9,256 patients receiving drug-eluting stents between January 2003 and August 2006. We classified patients ac...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Petersen JL,Barron JJ,Hammill BG,Cziraky MJ,Anstrom KJ,Wahl PM,Eisenstein EL,Krucoff MW,Califf RM,Schulman KA,Curtis LH

    更新日期:2010-03-01 00:00:00

  • Design and rationale for the Stimulation Of the Left Ventricular Endocardium for Cardiac Resynchronization Therapy in non-responders and previously untreatable patients (SOLVE-CRT) trial.

    abstract:BACKGROUND:Cardiac resynchronization therapy (CRT) improves outcomes, functional capacity and quality of life in patients with heart failure. Despite two decades of experience with CRT, the rate of non-response remains approximately 30%. CRT efficacy is impacted by pacing location, which is anatomically limited in conv...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Singh JP,Abraham WT,Auricchio A,Delnoy PP,Gold M,Reddy VY,Sanders P,Lindenfeld J,Rinaldi CA

    更新日期:2019-11-01 00:00:00

  • Prolonged QT interval in neonates: benign, transient, or prolonged risk of sudden death.

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    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Villain E,Levy M,Kachaner J,Garson A Jr

    更新日期:1992-07-01 00:00:00

  • Effects of intra-aortic balloon counterpulsation on coronary pressure in patients with stenotic coronary arteries.

    abstract:BACKGROUND:The benefits of intra-aortic balloon pumping (IABP) usage reportedly occur through systolic unloading of the left ventricle and the augmentation of diastolic coronary flow. The aim of this study was to assess the change in intracoronary pressure distal to the coronary stenosis after the IABP by using an intr...

    journal_title:American heart journal

    pub_type: 杂志文章,随机对照试验


    authors: Yoshitani H,Akasaka T,Kaji S,Kawamoto T,Kume T,Neishi Y,Koyama Y,Yoshida K

    更新日期:2007-10-01 00:00:00

  • Effect of center catheterization volume on risk of catastrophic adverse event after cardiac catheterization in children.

    abstract:BACKGROUND:Procedural volume has been shown to be associated with outcome in cardiac catheterization and intervention in adults. The impact of center-level factors (such as volume) and their interaction with subject- and procedure-level factors on outcome after cardiac catheterization in children is not well described....

    journal_title:American heart journal

    pub_type: 杂志文章,多中心研究


    authors: O'Byrne ML,Glatz AC,Shinohara RT,Jayaram N,Gillespie MJ,Dori Y,Rome JJ,Kawut S

    更新日期:2015-06-01 00:00:00

  • Effect of intravenous adenosine on myocardial reperfusion injury in a model with low myocardial collateral blood flow.

    abstract::The purpose of this study was to investigate the effects of various doses of adenosine administered intravenously on myocardial reperfusion injury in a model with poor collateral blood flow. New Zealand White rabbits were subjected to 30 minutes of occlusion of the obtuse marginal branch of the left circumflex artery ...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Norton ED,Jackson EK,Virmani R,Forman MB

    更新日期:1991-11-01 00:00:00

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    abstract::Left ventricular mass (LVM) measurements made by the truncated ellipsoid algorithm from clinical two-dimensional echocardiograms (2DE) were compared to autopsy weights in 37 patients. All six 2DE instruments were calibrated with an ultrasound phantom to standardize LVM measurements. Measurements were made by an experi...

    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Byrd BF 3rd,Finkbeiner W,Bouchard A,Silverman NH,Schiller NB

    更新日期:1989-07-01 00:00:00

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    pub_type: 社论,评审


    authors: Gussenhoven EJ,van der Lugt A,van der Steen AF,Ligtvoet KM

    更新日期:1996-09-01 00:00:00

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    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

  • The impact of oral antiplatelet responsiveness on the long-term prognosis after coronary stenting.

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    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Foussas SG,Zairis MN,Patsourakos NG,Makrygiannis SS,Adamopoulou EN,Handanis SM,Prekates AA,Fakiolas CN,Pissimissis EG,Olympios CD,Argyrakis SK

    更新日期:2007-10-01 00:00:00

  • Sensitivity and specificity of echocardiographic identification of patients eligible for safe early discharge after acute myocardial infarction.

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    journal_title:American heart journal

    pub_type: 临床试验,杂志文章


    authors: Launbjerg J,Berning J,Fruergaard P,Appleyard M

    更新日期:1992-10-01 00:00:00

  • Influence of gradually increased slow balloon inflation on restenosis after coronary angioplasty.

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    journal_title:American heart journal

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Miketic S,Carlsson J,Tebbe U

    更新日期:1998-04-01 00:00:00

  • Gender-specific outcomes after balloon aortic valvuloplasty: Inhospital and long-term outcomes.

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    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Christodoulidis G,Yu J,Kini A,Dangas GD,Baber U,Melissa A,Sartori S,Theodoropoulos K,Bhat A,Kovacic J,Moreno P,Krishnan P,Mehran R,Sharma S

    更新日期:2015-07-01 00:00:00

  • Right ventricular myocardial infarction with anterior wall left ventricular infarction: an autopsy study.

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    journal_title:American heart journal

    pub_type: 杂志文章


    authors: Cabin HS,Clubb KS,Wackers FJ,Zaret BL

    更新日期:1987-01-01 00:00:00