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. While the GRACE risk score (GRS) is a guideline advocated, well-validated risk stratification tool, its utility in improving care and outcomes remains unproven, and its application has been limited in routine clinical practice. OBJECTIVE:This study will assess the effectiveness using the GRS tool and treatment recommendations during patient assessment on improving the application of guideline-recommended therapies in ACS care. DESIGN:This study employs a PROBE (prospective cluster [hospital-level] randomized open-label, blinded endpoint) design to evaluate objective measures of hospital performance, with clinical events adjudicated by a blinded event committee. This randomized study is nested within the established CONCORDANCE registry of ACS patients, with existing methods for data collection and monitoring of care and clinical outcomes. The hospital-level intervention is the integration of the GRS into routine ACS patient assessment process. The study will assess the use of early invasive management, prescription of guideline recommended pharmacology and referral to cardiac rehabilitation by hospital discharge; with the key composite clinical endpoint of cardiovascular death, new or recurrent myocardial infarction, in-hospital heart failure or cardiovascular readmission at 12 months. Health economic impacts of risk stratification implementation will also be evaluated. The study will recruit 3000 patients from 30 hospitals. SUMMARY:The AGRIS trial will establish the effect of routine objective risk stratification using the GRACE risk score on ACS care and clinical outcomes.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Chew DP,Astley CM,Luker H,Alprandi-Costa B,Hillis G,Chow CK,Quinn S,Yan AT,Gale CP,Goodman S,Fox KA,Brieger Ddoi
10.1016/j.ahj.2015.07.032subject
Has Abstractpub_date
2015-11-01 00:00:00pages
995-1004.e1issue
5eissn
0002-8703issn
1097-6744pii
S0002-8703(15)00530-Xjournal_volume
170pub_type
杂志文章,多中心研究,随机对照试验abstract::Twenty-seven patients with asymptomatic, nonsustained ventricular tachycardia whose evaluation suggested they were at high risk for sustained ventricular arrhythmias were treated with implantable cardioverter defibrillators. The option of conventional therapy (including the option of no therapy) was presented to each ...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/s0002-8703(96)90051-4
更新日期:1996-01-01 00:00:00
abstract::To test alterations in plasma potassium and magnesium levels with maximal exercise, 15 sedentary, healthy men (mean age 29 years) participated in a double-blind crossover study for 11 weeks with propranolol, atenolol, and placebo. Maximal exercise tests were done at baseline and after placebo and beta-blockade phases....
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(91)90962-h
更新日期:1991-01-01 00:00:00
abstract:BACKGROUND:Depressive symptoms in patients with heart failure (HF) are common and might be associated with inflammation. No studies have examined both the cross-sectional and prospective association between inflammation and depressive symptoms in patients with HF with adequate correction for disease severity. The aim o...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2011.03.011
更新日期:2011-06-01 00:00:00
abstract::Valve area and cardiac output were determined with magnetic resonance (MR) velocity mapping in 12 patients with aortic stenosis. Heart catheterization, Doppler echocardiography, and indicator dilution were performed for comparison. Left ventricle could be catheterized in only nine patients; in these cases, MR measured...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90669-z
更新日期:1993-11-01 00:00:00
abstract::The long-term efficacy and safety of flecainide (100 to 200 mg twice a day) were evaluated in 21 patients with high-grade, chronic ventricular arrhythmias who responded to and tolerated flecainide at a preliminary evaluation (200 mg, single oral dose). Antiarrhythmic response was evaluated at 3 days and 3, 6, 12, 18, ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90404-3
更新日期:1989-06-01 00:00:00
abstract:BACKGROUND:The diagnosis of angina is challenging because it relies on symptom descriptions. Natural language processing (NLP) of the electronic medical record (EMR) can provide access to such information contained in free text that may not be fully captured by conventional diagnostic coding. OBJECTIVE:To test the hyp...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2006.12.022
更新日期:2007-04-01 00:00:00
abstract:BACKGROUND:Recently, long (> or =20 mm) coronary stents were introduced for clinical use. They are intended as an alternative to multiple conventional stents to treat extensive dissections or suboptimal results of long lesions after balloon angioplasty. METHODS:In a total of 113 such consecutive vessels in 107 patient...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1053/hj.1998.v136.89578
更新日期:1998-08-01 00:00:00
abstract:BACKGROUND:The significance of troponin elevation and clinical utility of troponin testing in ambulatory patients with coronary artery disease (CAD) have not been examined. We sought to investigate the prevalence and prognostic value of cardiac troponin T (cTnT) elevation in a population with stable CAD. METHODS:We st...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2009.07.021
更新日期:2009-10-01 00:00:00
abstract::The incidence of cardiac events in Japanese men (mean age 54 +/- 10 years) with atypical or nonanginal chest pain was assessed prospectively. Three groups of patients, those with typical angina (TA; n = 134), those with atypical angina (AA; n = 192), and those with nonanginal chest pain (NA; n = 311) were studied with...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90802-3
更新日期:1992-06-01 00:00:00
abstract::Antiplatelet therapy has been shown to significantly reduce the risk of serious vascular events in high-risk patients, including those with a prior acute ischemic event. The long-term use of antiplatelet agents is a key component of secondary prevention measures following acute coronary syndromes, including ST-segment...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2010.10.014
更新日期:2010-12-01 00:00:00
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
doi:10.1067/mhj.2001.114804
更新日期:2001-05-01 00:00:00
abstract::We investigated the incidence and mechanism of pulmonary artery hypertension (PAH) in a consecutive series of patients with aortic stenosis who were undergoing diagnostic cardiac catheterization. Forty-five patients with severe aortic stenosis were divided into two groups: group 1 comprised 13 patients (29%) with PAH ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90067-j
更新日期:1993-01-01 00:00:00
abstract::The influence of blood medium on tissue ablation by a pulsed dye laser and its selectivity for atheroma were investigated. The role of shock waves on tissue ablation was also evaluated. Normal and atherosclerotic human aortas were irradiated by a 480 nm pulsed dye laser activated at 5 Hz. The laser was coupled with a ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90529-q
更新日期:1991-09-01 00:00:00
abstract:BACKGROUND:The type of practitioners who use the standard exercise test is changing. Once a tool of the cardiologist, the standard exercise test is now being performed by internists and other noncardiologists. Because this change could be facilitated by computerization similar to the computerized interpretation program...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/s0002-8703(98)70233-9
更新日期:1998-09-01 00:00:00
abstract::The aim of our study was to compare the outcome of patients with a first acute myocardial infarction (AMI) among three large cohorts of patients hospitalized between 1966 and 1992 in Israel, in view of changes in treatment facilities and investigation methods. Patients with a first AMI constituted 71% of all myocardia...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/0002-8703(95)90351-8
更新日期:1995-09-01 00:00:00
abstract::Changes in conduction times induced by ischemia (delta CT) have been shown to be quantitatively related to genesis of spontaneous ischemic ventricular fibrillation (VF). We studied conduction delay encountered by premature impulses in epicardium and endocardium in both anterograde and retrograde directions during isch...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(81)90308-2
更新日期:1981-09-01 00:00:00
abstract:OBJECTIVE:The study aimed to determine the impact on eptifibatide-associated bleeding by implementing a computerized dosing algorithm in the cardiac catheterization suite. BACKGROUND:Excessive dosing of eptifibatide is associated with increased bleeding rates and hospital mortality. Although dosing adjustments based o...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2009.10.006
更新日期:2009-12-01 00:00:00
abstract::Congenitally corrected transposition of the great arteries (ccTGA) is associated with various types of arrhythmia, including supraventricular tachycardia (SVT) and complete atrioventricular block (cAVB). Our study aims to characterize the arrhythmia burden, associated risk factors, arrhythmia mechanisms, and the long-...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2020.10.057
更新日期:2021-01-01 00:00:00
abstract::This article reviews the evidence that congestive heart failure is accompanied by an increased plasma norepinephrine concentration and that this is due not only to a reduced tissue clearance of the substance but also to a marked increase in sympathetic nerve activity. It also reports data that indicate that the sympat...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(90)90054-2
更新日期:1990-12-01 00:00:00
abstract:BACKGROUND:Larger studies evaluating the angiographic results of second-generation stents are scarce. The objectives of this study were to assess current standards of angiographic and clinical outcomes after implantation of the second-generation stainless steel stent, NIR (Medinol Ltd, Tel Aviv, Israel), and to compare...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1067/mhj.2003.32
更新日期:2003-02-01 00:00:00
abstract::Despite gratifying immediate results, significant recoarctation at follow-up has been observed after balloon angioplasty of native aortic coarctation. Risk factors for such recurrences have been identified in one of our previous studies. In this study we examined the value of these risk factors in the prediction of re...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(95)90245-7
更新日期:1995-07-01 00:00:00
abstract:BACKGROUND:Few data are available concerning the effects on clinical outcome and left ventricular function of abciximab administration in patients undergoing rescue percutaneous transluminal coronary angioplasty (PTCA) after failed thrombolysis for acute myocardial infarction. The aim of the study was to investigate su...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/mhj.2002.119762
更新日期:2002-02-01 00:00:00
abstract::Two hundred twenty-four patients underwent ventricular programmed stimulation (VPS) without prior documentation of the clinical occurrence of sustained ventricular tachycardia (VT) or ventricular fibrillation-flutter (VF). Indications for VPS were: palpitations or nonsustained VT during ambulatory monitoring (85 patie...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(85)90235-2
更新日期:1985-05-01 00:00:00
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
doi:10.1016/0002-8703(89)90083-5
更新日期:1989-07-01 00:00:00
abstract:BACKGROUND:Myocardial infarction (MI) complicated by cardiogenic shock (CS) is associated with high mortality. Early coronary revascularization improves survival, but the optimal mode of revascularization remains uncertain. We sought to characterize practice patterns and outcomes of coronary artery bypass grafting (CAB...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2020.01.020
更新日期:2020-08-01 00:00:00
abstract::The hemodynamic, electrocardiographic, and metabolic responses of dogs with acute myocardial ischemia to intravenous administration of fructose-1,6-diphosphate (FDP) were assessed. Analysis of the results (compared to dextrose control) revealed evidence of major improvement of LVEDP and cardiac output, significant dec...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(80)90228-8
更新日期:1980-11-01 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:BACKGROUND:The purpose of our study was to evaluate the implementation of guidelines for the treatment of cardiogenic shock (CS) complicating the acute coronary syndromes (ACS). METHODS AND RESULTS:Of the 10 136 patients in the Euro-Heart-Survey-ACS with complete data, CS occurred in 549 (5.4%), of whom 28.6% had CS u...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.06.004
更新日期:2005-01-01 00:00:00
abstract::Right- and left-sided endocarditis are two distinct entities, both clinically and experimentally. As such, they require different clinical approaches. The accurate diagnosis of right-sided endocarditis rests largely on a high index of suspicion which is often raised in the case of an intravenous drug abuser with fever...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(86)90564-8
更新日期:1986-01-01 00:00:00
abstract:BACKGROUND:The effect of age on diagnostic and prognostic performance of high-sensitivity cardiac troponin T (hs-cTnT) has not been addressed adequately, so far. METHODS:High-sensitivity cardiac troponin T was measured serially in patients with acute symptoms presenting to our emergency department. We tested the diagn...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2012.08.003
更新日期:2012-11-01 00:00:00