Abstract:
BACKGROUND:The aim of this study was to assess one-year outcomes of invasive and non-invasive strategies in ST-elevation myocardial infarction (STEMI) among multimorbid older people with complex health needs. METHODS:We included patients, registered between 2006 and 2013 in the SWEDEHEART registry, who were 70 years old or older with STEMI, had multimorbidity and complex health needs and were discharged alive. The one-year outcomes of patients who underwent invasive strategy (examined with coronary angiography ≤14 days) were compared to those who did not. The primary event was a composite of all-cause death, admission due to new acute coronary syndrome, stroke or transient ischemic attack. RESULTS:We identified patients, and 1089 were managed invasively and 570 non-invasively. The mean age was 79 years and 83 years in the 2 groups, respectively. After multivariable adjustment for baseline differences between the groups, including propensity scores, the primary event occurred in 31% of patients in the invasive group and 55% in the non-invasive group, adjusted hazard ratio (95% confidence intervals): 0.67 (0.54-0.83). One-year mortality was 18% in the invasive group and 45% in the non-invasive group, adjusted hazard ratio 0.51 (0.39-0.65). CONCLUSIONS:Multimorbid older people with complex health needs and STEMI had high rates of new ischemic events and death. In this cohort of older, high risk STEMI patients, an invasive strategy was associated with lower event rates. Randomized studies are needed to clarify whether these high risk patients who might benefit from invasive care are being managed too conservatively.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Gudnadottir GS,James SK,Andersen K,Lagerqvist B,Thrainsdottir IS,Ravn-Fischer A,Varenhorst C,Gudnason Tdoi
10.1016/j.ahj.2019.01.008subject
Has Abstractpub_date
2019-05-01 00:00:00pages
11-21eissn
0002-8703issn
1097-6744pii
S0002-8703(19)30019-5journal_volume
211pub_type
杂志文章abstract::The long-term prognosis of patients successfully resuscitated from cardiac arrest who do not have acute precipitating factors and in whom ventricular arrhythmias cannot be induced during baseline electrophysiologic testing is controversial. The purpose of this investigation was to evaluate the long-term risk of recurr...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(90)90245-s
更新日期:1990-12-01 00:00:00
abstract::To assess the effects of standard therapeutic interventions on the total ischemic burden, 86 patients with stable angina underwent 48 hours of ambulatory ST segment monitoring and treadmill exercise testing before and at a mean of 10 weeks after coronary artery bypass surgery (CABG) (group 1, N = 46) or percutaneous t...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(92)90495-h
更新日期:1992-03-01 00:00:00
abstract::Reductions in mobility and cognitive function linked to accrual of brain microvascular disease related white matter hyperintensities (WMHs) on magnetic resonance imaging can occur in older hypertensive patients in as little as 2 years. We have designed a trial evaluating 2 levels of ambulatory blood pressure (ABP) con...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2012.11.008
更新日期:2013-03-01 00:00:00
abstract::The objectives of this study were to assess current practice patterns in pharmacotherapy for congestive heart failure at an academic medical center and to analyze temporal trends in management of congestive heart failure from 1990 to 1995. Records of all patients discharged from the hospital in 1990 or 1995 with a pri...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(98)70309-6
更新日期:1998-03-01 00:00:00
abstract:BACKGROUND:Only limited data from large randomized clinical trials have been published on the long-term performance of second-generation drug-eluting stents in bifurcation lesions. METHODS:We investigated in patients in the randomized TWENTE trial the long-term safety and efficacy of treating bifurcation lesions with ...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2014.10.011
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:The diagnostic value of 12-lead electrocardiography during dobutamine stress echocardiography (DSE) is not well documented. METHODS AND RESULTS:We reviewed the records of 116 patients referred for DSE and coronary angiography, 52 of whom were excluded because of abnormal ST segment or inadequate DSE. Of the...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(98)70163-2
更新日期:1998-12-01 00:00:00
abstract::The pathophysiologic features and clinical manifestations of HCM have been elucidated by the introduction of several new diagnostic options. Knowledge of the molecular defects of HCM has advanced rapidly, and genetic screening studies have reemphasized the value of the standard electrocardiogram as an initial screenin...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(96)90018-6
更新日期:1996-11-01 00:00:00
abstract:BACKGROUND:The study evaluates whether Optison used during dobutamine stress echocardiography (DSE) will improve endocardial border definition and whether this will translate to an improvement in sensitivity and specificity of the test in patients with poor echocardiographic windows. DSE is extremely valuable in the wo...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2001.117608
更新日期:2001-11-01 00:00:00
abstract::Early postexercise polarcardiographic (PCG) changes in the ST segment vector, as reflected in the variable MS X theta, are reported to clearly distinguish normal subjects from those with myocardial ischemia. We prospectively assessed the value of this test in detecting coronary artery disease (CAD) during treadmill ex...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(85)90019-5
更新日期:1985-12-01 00:00:00
abstract:BACKGROUND:Although recent data support an early invasive management in acute coronary syndromes (ACS), overall evidence appears conflicting. We performed a metaregression to explore the impact of intracoronary stenting and aggressive antiplatelet treatment on the risk/benefit ratio of an early invasive approach. METH...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2004.10.026
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:The ODYSSEY COMBO I study (http://clinicaltrials.gov/show/NCT01644175) evaluated efficacy and safety of alirocumab as add-on therapy to stable maximally tolerated daily statin with or without other lipid-lowering therapy in high cardiovascular risk patients with suboptimally controlled hypercholesterolemia. ...
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.2015.03.004
更新日期:2015-06-01 00:00:00
abstract::Left ventricular (LV) adaptation to the hemodynamic load of pregnancy has been studied with load-sensitive ejection-phase indexes, but the results of these studies are conflicting. The aim of this study was to examine the effects of the hemodynamic load of pregnancy on the contractile state of the left ventricle by us...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(97)70247-3
更新日期:1997-01-01 00:00:00
abstract::Bacterial shock due to Gram-negative bacilli is best managed by prompt control of the infection with appropriate antibiotics and surgical drainage or excision. Corticosteroids for purposes of controlling systemic reactions to bacteria and their toxins constitute adjunctive therapy. Volume repletion and respiratory sup...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(77)80352-9
更新日期:1977-07-01 00:00:00
abstract::In order to study the origin of the basal systolic murmurs in mitral stenosis, left and right heart catheterization was performed in 18 patients with mitral stenosis using intracardiac phonocardiography. Our data revealed that the basal systolic murmurs originated in the aorta, the pulmonary artery, and the outflow tr...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(78)90163-1
更新日期:1978-10-01 00:00:00
abstract::The records of 64 patients with progressive systemic sclerosis (PSS) were reviewed. More than 100 items from the patient's history, physical examination, and laboratory tests were encoded. A two-tailed Gehan's test was used to evaluate the effect of each variable on patient survival. Variables significant at the 0.05 ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(85)90525-3
更新日期:1985-07-01 00:00:00
abstract:OBJECTIVES:To characterize patient profile and hemodynamic profile of those undergoing intra-aortic balloon pump (IABP) for cardiogenic shock and define predictors of hemodynamic failure of IABP support. BACKGROUND:Clinical characteristics of IABP support in cardiogenic shock not related to acute myocardial infarction...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2017.11.016
更新日期:2018-05-01 00:00:00
abstract::A substantial proportion of patients with dilated cardiomyopathy have circulating autoantibodies directed against the cardiac beta-adrenoceptor. These antireceptor antibodies inhibit both ligand binding to membrane beta-receptors and isoproterenol-sensitive adenylate cyclase. The functional consequences of antibody-re...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90766-b
更新日期:1991-07-01 00:00:00
abstract::The results of percutaneous transluminal coronary angioplasty (PTCA) in 307 lesions in 235 patients within 60 days of myocardial infarction (MI) were compared with the PTCA results in 591 lesions in 489 patients without recent MI, and the effect of fibrinolysis to treat recurring occlusive clot during angioplasty was ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(90)90065-6
更新日期:1990-08-01 00:00:00
abstract::To test the feasibility of synchronized retroperfusion (SRP) as a support device of percutaneous transluminal coronary angioplasty (PTCA) for high-risk patients, 10 patients with left main trunk or near left main trunk obstruction underwent PTCA with SRP. An 8.5F retroperfusion catheter was inserted from the antecubit...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90004-s
更新日期:1993-02-01 00:00:00
abstract:BACKGROUND:Biolimus-eluting stents (BESs) with a biodegradable polymer in abluminal coating achieve more complete coverage at 9 months compared with sirolimus-eluting stents (SESs) with a durable polymer, as assessed by optical coherence tomography (OCT). Whether this advantage persists or augments after complete resor...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2011.09.005
更新日期:2011-11-01 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:Evidence from numerous studies of coronary angiography show differences between observers' assessments of 15% to 45%. The implication of this variation is serious: If readings are erroneous, some patients will undergo revascularization procedures unnecessarily and others will be denied an essential treatment...
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/s0002-8703(00)90316-8
更新日期:2000-01-01 00:00:00
abstract::There has been considerable debate regarding the value of programmed electrical stimulation in patients who present with asymptomatic, or minimally symptomatic, nonsustained VT. Unfortunately, there has never been a sufficiently large study of an untreated group of patients to make any sense of the issue. We culled th...
journal_title:American heart journal
pub_type: 杂志文章,meta分析
doi:10.1016/0002-8703(92)90664-h
更新日期:1992-02-01 00:00:00
abstract::The presence and severity of functional mitral regurgitation were quantified by Doppler echocardiography in 17 patients with dilated cardiomyopathy and no evidence of primary valvular disease. Mitral regurgitant fraction was greater than 20% in 11 of the 17 patients, and exceeded 40% in four patients. Total stroke vol...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90334-1
更新日期:1988-09-01 00:00:00
abstract:BACKGROUND:Despite lower risks of access site-related complications with transradial approach (TRA), its clinical benefit for percutaneous coronary intervention (PCI) is uncertain. We conducted a systematic review and meta-analysis of clinical studies comparing TRA and transfemoral approach (TFA) for PCI. METHODS:Rand...
journal_title:American heart journal
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.ahj.2012.01.015
更新日期:2012-04-01 00:00:00
abstract::Percutaneous balloon mitral valvuloplasty has been shown to be an effective means of reducing mitral valve gradient and increasing mitral valve area in patients with mitral stenosis. Most techniques currently employed for performing this procedure involve delivery of one or two balloon valvuloplasty catheters through ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(05)80279-0
更新日期:1990-03-01 00:00:00
abstract::Pressor response to norepinephrine, cardiopulmonary blood volume, and hemodynamic parameters were studied in 41 borderline hypertensive patients in comparison with 42 permanent essential hypertensive patients and 28 normal subjects. Borderline hypertensive subjects had high cardiac index (p less than 0.0001), normal t...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90155-6
更新日期:1975-04-01 00:00:00
abstract::Evaluation of mitral regurgitation is difficult whether invasive or noninvasive methods are used. The determination of the regurgitant volume itself cannot be done in clinical practice with reasonable accuracy. In six sheep with chronic mitral regurgitation, left ventricular and left atrial pressures were recorded wit...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(95)90009-8
更新日期:1995-02-01 00:00:00
abstract:BACKGROUND:We aim to validate the diagnostic performance of the first fully automatic, electronic heart failure (HF) identification algorithm and evaluate the implementation of an HF Dashboard system with 2 components: real-time identification of decompensated HF admissions and accurate characterization of disease char...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2016.10.001
更新日期:2017-01-01 00:00:00
abstract::We investigated the relationship between plasma atrial natriuretic polypeptide (ANP) levels and hemodynamic indices during dynamic exercise testing in 15 patients with effort angina pectoris. Patients exercised on an angina-limited, supine, multistage bicycle ergometer, and plasma ANP levels and hemodynamic indices we...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(90)90239-t
更新日期:1990-12-01 00:00:00