Abstract:
BACKGROUND:Clinical outcomes and the effects of oral anticoagulants among patients with acute coronary syndrome (ACS) and either a history of or acute heart failure (HF) are largely unknown. We aimed to assess the relationship between prior HF or acute HF complicating an index ACS event and subsequent clinical outcomes and the efficacy and safety of apixaban compared with placebo in these populations. METHODS:High-risk patients were randomly assigned post-ACS to apixaban 5.0 mg or placebo twice daily. Median follow-up was 8 (4-12) months. The primary outcome was cardiovascular death, myocardial infarction, or stroke. The main safety outcome was thrombolysis in myocardial infarction major bleeding. RESULTS:Heart failure was reported in 2,995 patients (41%), either as prior HF (2,076 [28%]) or acute HF (2,028 [27%]). Patients with HF had a very high baseline risk and were more often managed medically. Heart failure was associated with a higher rate of the primary outcome (prior HF: adjusted hazard ratio [HR] 1.73, 95% CI 1.42-2.10, P < .0001, acute HF: adjusted HR 1.65, 95% CI 1.35-2.01, P < .0001) and cardiovascular death (prior HF: HR 2.54, 95% CI 1.82-3.54, acute HF: adjusted HR 2.52, 95% CI 1.82-3.50). Patients with acute HF also had significantly higher rates of thrombolysis in myocardial infarction major bleeding (prior HF: adjusted HR 1.22, 95% CI 0.65-2.27, P = .54, acute HF: adjusted HR 1.78, 95% CI 1.03-3.08, P = .04). There was no statistical evidence of a differential effect of apixaban on clinical events or bleeding in patients with or without prior HF; however, among patients with acute HF, there were numerically fewer events with apixaban than placebo (14.8 vs 19.3, HR 0.76, 95% CI 0.57-1.01, interaction P = .13), a trend that was not seen in patients with prior HF or no HF. CONCLUSIONS:In high-risk patients post-ACS, both prior and acute HFs are associated with an increased risk of subsequent clinical events. Apixaban did not significantly reduce clinical events and increased bleeding in patients with and without HF; however, there was a tendency toward fewer clinical events with apixaban in patients with acute HF.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Cornel JH,Lopes RD,James S,Stevens SR,Neely ML,Liaw D,Miller J,Mohan P,Amerena J,Raev D,Huo Y,Urina-Triana M,Gallegos Cazorla A,Vinereanu D,Fridrich V,Harrington RA,Wallentin L,Alexander JH,APPRAISE-2 Study Group.doi
10.1016/j.ahj.2014.12.022subject
Has Abstractpub_date
2015-04-01 00:00:00pages
531-8issue
4eissn
0002-8703issn
1097-6744pii
S0002-8703(15)00016-2journal_volume
169pub_type
杂志文章,随机对照试验abstract:BACKGROUND:Achieving a therapeutic international normalized ratio (INR) before hospital discharge is an important inpatient goal for patients undergoing mechanical cardiac valve replacement (MCVR). The use of clinical algorithms has reduced the time to achieve therapeutic INR (TTI) with warfarin therapy. Whether TTI pr...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2017.02.011
更新日期:2017-05-01 00:00:00
abstract::Atrial antitachycardia pacing was tested in 23 children and young adults. The majority of these patients had had operative repair of congenital cardiac defects and had both bradycardia and tachycardia. Pacemakers were usually implanted by the transvenous technique using bipolar leads. In each patient it was possible t...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90534-o
更新日期:1991-09-01 00:00:00
abstract::The prevalence of heart failure (HF) is high and still on the rise. In 2004, an estimated 5.2 million adults in the United States carried the diagnosis of HF with a mortality rate of >19%. The incidence of HF is higher in individuals 65 years or older. As the US population grows older, the personal and economic costs ...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2009.04.007
更新日期:2009-06-01 00:00:00
abstract::Under electrophysiologic studies, 44 asymptomatic chagasic individuals were studied. The mean age was 39.9 years, with 26 being male. The surface ECG showed normal tracings in 12 patients, left anterior fascicular block in three, incomplete right bundle branch block in two, and right bundle branch block in 27 (isolate...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90206-5
更新日期:1983-08-01 00:00:00
abstract::The associations between socioeconomic status, ethnic origin, and risk factors for CHD were studied in 2,591 white and black children from two socioeconomically dissimilar populations in the New York City area. The study subjects were selected from all fourth graders in 44 elementary schools. Blood pressure, plasma li...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90724-1
更新日期:1987-03-01 00:00:00
abstract::To determine the frequency and significance of left ventricular wall motion abnormalities in patients without clinical evidence of myocardial infarction, we reviewed the two-dimensional echocardiograms of 252 patients who had no history or electrocardiographic evidence of myocardial infarction and who subsequently und...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90666-6
更新日期:1991-04-01 00:00:00
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
doi:10.1016/j.ahj.2015.02.018
更新日期:2015-06-01 00:00:00
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...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2011.02.004
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:There are limited data assessing statin therapy in patients with nonobstructive coronary plaque on coronary computed tomography angiography (CCTA). METHODS:Two hundred six consecutive patients with mild noncalcified plaque on CCTA were enrolled in this multicenter prospective observational study. Subjects w...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2016.06.023
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:Elevated resting heart rate (RHR) is known to be associated with reduced survival but inconsistencies remain, including lack of significance in most studies of healthy women, lack of independence from systolic blood pressure (SBP) in some, and the suggestion that RHR is merely functioning as a marker of phys...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2009.12.029
更新日期:2010-04-01 00:00:00
abstract::We studied the effect of propranolol administration on risk assessment based on submaximal exercise testing performed early after myocardial infarction. A total of 70 patients with recent infarction underwent modified Bruce treadmill testing with simultaneous measurement of expired gases in the absence of antianginal ...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(91)90009-7
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND:Serum levels of pregnancy-associated plasma protein-A (PAPP-A) have recently been linked to plaque instability and are increased in acute coronary syndromes. The relation between PAPP-A levels and coronary risk factors, namely blood lipids, has not been studied to date. We have therefore investigated whether...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/S0002-8703(03)00446-0
更新日期:2003-12-01 00:00:00
abstract::One hundred thirty-three patients with dilated heart failure, 80 with coronary artery disease, and 53 with idiopathic dilated cardiomyopathy were followed for a mean of 29 months. Patients with ischemic heart disease had a worse prognosis than those classified as having idiopathic cardiomyopathy. Features from history...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(05)80242-x
更新日期:1990-05-01 00:00:00
abstract::The results of surgical therapy performed in 51 consecutive patients with ventricular tachycardia were reviewed to determine short- and long-term predictors of success of such therapy in preventing recurrences of life-threatening ventricular arrhythmias. Of 41 patients (80%) who survived surgery, 40 had postoperative ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90404-j
更新日期:1992-11-01 00:00:00
abstract::The present generation of implantable cardioverter defibrillators (ICDs) provides a very effective device for monitoring and treating life-threatening ventricular tachyarrhythmia. Patients at risk of sudden cardiac death who are directed to this form of treatment usually have severe coronary artery disease, previous m...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90087-6
更新日期:1994-04-01 00:00:00
abstract:BACKGROUND:The CPORT-E trial showed the noninferiority of nonprimary percutaneous coronary intervention (PCI) at hospitals without cardiac surgery on-site (SoS) compared with hospitals with SoS for 6-week mortality and 9-month major adverse cardiac events (MACE). However, target vessel revascularization (TVR) was incre...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2017.10.023
更新日期:2018-03-01 00:00:00
abstract::In the Cardiovascular Measurement System (CMS) the edge-detection algorithm, which was primarily designed for the Philips digital cardiac imaging system (DCI), is applied to cinefilms. Comparative validation of CMS and DCI was performed in vitro and in vivo with intracoronary insertion of stenosis phantoms in anesthet...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)91045-g
更新日期:1993-08-01 00:00:00
abstract::To evaluate the therapeutic efficacy of oral angiotensin-converting inhibition (ACE) with captopril in chronic normotensive congestive heart failure (CHF), acute and cardiocirculatory actions were determined by cardiac catheterization and forearm plethysmography, and ambulatory effects were assessed by echocardiograph...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(81)90379-3
更新日期:1981-01-01 00:00:00
abstract::Six hundred fifty seven patients with angina pectoris underwent coronary angiography after measurement of plasma fibrinogen levels. Coronary artery disease (CAD) was angiographically confirmed in 75% of the patients. Other cardiac disease, either alone or in combination with CAD, was diagnosed in 8% and 11% of cases, ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90747-w
更新日期:1993-06-01 00:00:00
abstract::In this study we have performed human leukocyte antigen (HLA)-A and B typing on nine patients with hypertrophic cardiomyopathy (HCM) and their relatives. Four patients had relatives who also had the disease. HLA typing of the familial form of HCM revealed a very close association of a given HLA-A,B haplotype with the ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90401-5
更新日期:1983-06-01 00:00:00
abstract:BACKGROUND:Dobutamine and exercise echocardiography are accepted as tests of comparable efficacy for the diagnosis of coronary artery disease. Although dobutamine has been classified as "exercise simulating," the mechanisms of ischemia with dobutamine and exercise have not been well studied. This study sought to compar...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(98)70183-8
更新日期:1998-07-01 00:00:00
abstract::Percutaneous transluminal coronary angioplasty (PTCA) was performed in 110 consecutive patients (111 vessels) with chronically occluded coronary arteries and was successful in 69 patients (69 vessels). Successful initial PTCA was related to the extent of coronary artery disease, the morphology of the proximal surface ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90503-7
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:Vascular wall shear stress (WSS) has been implied in the pathogenesis of atherosclerosis and vascular remodeling. Our aim was to calculate WSS after balloon angioplasty and evaluate its predictive value for long-term outcome. METHODS:WSS was calculated proximal to, in, and distal to the lesion after angiogr...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2002.123110
更新日期:2002-07-01 00:00:00
abstract:BACKGROUND:Assessing risk and weighing the potential benefits from evidence-based therapies are essential in the clinical decision making process of optimizing care and outcomes for patients presenting with acute coronary syndromes (ACS). Such practices are advocated in international clinical guidelines of ACS care. Wh...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2015.07.032
更新日期:2015-11-01 00:00:00
abstract::Three cases of rupture of the interventricular septum occurring coincident with acute inferior myocardial infarction are reported and the relevant literature is reviewed. One patient under-went successful surgical repair and, in addition, had an aneurysmectomy. Clues and pitfalls in diagnosis as well as the possible c...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(76)80407-3
更新日期:1976-07-01 00:00:00
abstract::Ambulatory ECG recordings are routinely used to identify patients at increased risk of sudden cardiac death and to monitor changes in ventricular arrhythmias during antiarrhythmic drug therapy. The arrhythmia frequency established during the initial baseline has previously been reported to change during a second place...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(88)90139-1
更新日期:1988-10-01 00:00:00
abstract::We attempted to determine whether exercise-induced silent myocardial ischemia has different clinical implications in patients with and without pathologic Q waves. We studied 152 patients (121 men and 31 women) who had ischemic ST depression (greater than or equal to 0.05 mV) during exercise tests and greater than or e...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(90)90009-m
更新日期:1990-09-01 00:00:00
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
doi:10.1016/j.ahj.2003.11.013
更新日期:2004-05-01 00:00:00
abstract::Although it has been shown that early cardiac rejection can be visualized by radioimmunoscintigraphy targeting major histocompatibility complex class II antigen, the use of antibodies that bind to a polymorphic determinant of class II antigen has certain disadvantages for clinical application. This investigation was d...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90050-7
更新日期:1994-05-01 00:00:00
abstract::A population of 2955 patients admitted to the hospital with acute myocardial infarction (AMI) was followed for 1 year after AMI or until death. Smokers as compared to nonsmokers were over 10 years younger (p less than 0.001) and had a lower prevalence of hypertension (p less than 0.01), congestive heart failure (p les...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(85)90071-7
更新日期:1985-09-01 00:00:00