Abstract:
:Background: In ISCHEMIA, an initial invasive strategy did not significantly reduce rates of cardiovascular events or all-cause mortality compared with a conservative strategy in patients with stable ischemic heart disease and moderate/severe myocardial ischemia. The most frequent component of composite cardiovascular endpoints was myocardial infarction. Methods: ISCHEMIA prespecified that the primary and major secondary composite endpoints of the trial be analyzed using two MI definitions. For procedural MI, the primary MI definition used CK-MB as the preferred biomarker whereas the secondary definition used cardiac troponin. Procedural thresholds were >5 times URL for PCI and >10 times for CABG. Procedural MI definitions included (i) a category of elevated biomarker only events with much higher biomarker thresholds (ii) new ST segment depression of ≥ 1mm for the primary and ≥ 0.5 mm for the secondary definition and (iii) new coronary dissections ≥ NHLBI grade 3. We compared MI type, frequency, and prognosis by treatment assignment using both MI definitions. Results: Procedural MI's accounted for 20.1% of all MI events with the primary definition and 40.6% of all MI events with the secondary definition. Four-year MI rates in patients undergoing revascularization were more frequent with the invasive vs conservative strategy using the primary [2.7% vs. 1.1%; adjusted HR 2.98 (95% CI 1.87, 4.73)] and secondary [8.2% vs. 2.0%; adjusted HR 5.04 (95% CI 3.64, 6.97)] MI definitions. Type 1 MI's were less frequent with the invasive vs conservative strategy using the primary [3.40% vs. 6.89%; adjusted HR 0.53 (95% CI 0.41,0.69); p<0.0001], and secondary [3.48% vs 6.89%; adjusted HR 0.53 (95% CI 0.41, 0.69); p<0.0001] definitions. The risk of subsequent cardiovascular death was higher after a type 1 MI compared to no MI using the primary [adjusted HR 3.38 (95% CI 2.03,5.61); p<0.001] or secondary MI definition [adjusted HR 3.52 (2.11, 5.88); p<0.001]. Conclusions: In ISCHEMIA, type 1 MI events using the primary and secondary definitions during 5-year follow-up were more frequent with an initial conservative strategy and associated with subsequent cardiovascular death. Procedural MI rates were greater in the invasive strategy and using the secondary MI definition. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT01471522.
journal_name
Circulationjournal_title
Circulationauthors
Chaitman BR,Alexander KP,Cyr DD,Berger JS,Reynolds HR,Bangalore S,Boden WE,Lopes RD,Demkow M,Perna GP,Riezebos RK,McFalls EO,Banerjee S,Bagai A,Gosselin G,O'Brien SM,Rockhold FW,Waters DD,Thygesen KA,Stone GW,Whitdoi
10.1161/CIRCULATIONAHA.120.047987subject
Has Abstractpub_date
2020-12-03 00:00:00eissn
0009-7322issn
1524-4539pub_type
杂志文章相关文献
CIRCULATION文献大全abstract::A technique is described to control recurrent or sustained supraventricular tachycardia associated with rapid ventricular rates following open heart surgery. The technique utilizes a pair of temporarily implanted atrial epicardial wire electrodes to pace the heart. In one group of patients with recurrent atrial flutte...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.54.2.245
更新日期:1976-08-01 00:00:00
abstract:BACKGROUND:Increased homocysteine levels are a risk factor for atherosclerosis and its sequelae. A common genetic mutation in methylenetetrahydrofolate reductase (MTHFR), an enzyme required for efficient homocysteine metabolism, creates a thermolabile enzyme with reduced activity. We determined the prevalence of this m...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.94.12.3074
更新日期:1996-12-15 00:00:00
abstract:BACKGROUND:Immunization with cardiac myosin induces experimental autoimmune heart disease in genetically predisposed mice. These mice produce heart-specific autoantibodies, some of which are directed against the cardiac myosin isoform. METHODS AND RESULTS:We have reported the presence of circulating heart-specific aut...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.85.5.1734
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:Systemic markers of inflammation have been found in unstable angina. Disruption of culprit coronary stenoses may cause a greater inflammatory response in patients with unstable than those with stable angina. We assessed the time course of C-reactive protein (CRP), serum amyloid A protein (SAA), and interleuk...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.98.22.2370
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND:Thrombolytic therapy of acute myocardial infarction (AMI) is evolving toward bolus administration. Derivatization of proteins with polyethylene glycol (PEG) may reduce their clearance. METHODS AND RESULTS:A staphylokinase (SakSTAR) variant with 12 amino acid substitutions to reduce its antigenicity, SakSTAR...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.102.15.1766
更新日期:2000-10-10 00:00:00
abstract:BACKGROUND:Compared with single-chamber ventricular pacing, dual-chamber pacing can reduce adverse events and, as a result, improve quality of life in patients paced for sick sinus syndrome. It is not clear, however, how these benefits compare with the increased cost of dual-chamber pacemakers. METHODS AND RESULTS:We ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000151810.69732.41
更新日期:2005-01-18 00:00:00
abstract:BACKGROUND:Several mechanisms have been advanced to explain Mobitz type II atrioventricular block in the ischemically damaged His-Purkinje system. Only recently, however, has an animal model been developed to study this form of conduction defect in vivo and in vitro. METHODS AND RESULTS:Conduction defects were induced...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.87.4.1389
更新日期:1993-04-01 00:00:00
abstract:BACKGROUND:Aspirin is effective for the primary prevention of cardiovascular events, but it remains unclear for which subgroups of individuals aspirin is beneficial. We assessed the cost-effectiveness of aspirin separately for men and women of different ages with various levels of cardiovascular disease risk. METHODS ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.107.735340
更新日期:2008-06-03 00:00:00
abstract:BACKGROUND:The most troublesome complication of acute pericarditis is recurrent episodes of pericardial inflammation, occurring in 15% to 32% of cases. The cause of the recurrence is usually unknown, although in some cases it may be traced to viral infection or may be a consequence of coronary artery bypass grafting. T...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/01.cir.97.21.2183
更新日期:1998-06-02 00:00:00
abstract:BACKGROUND:Current knowledge of prevalence, incidence, and survival in thoracic aortic diseases (aneurysm and dissection) is based on small studies from a dated era of treatment and diagnostic procedures. The objective of the present study was to reappraise epidemiology and long-term outcomes in subjects with thoracic ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.106.630400
更新日期:2006-12-12 00:00:00
abstract:BACKGROUND:Recent studies suggest that bone morphogenetic protein-2 (BMP-2), a transforming growth factor-beta superfamily member cytokine, plays an important role both in vascular development and pathophysiological processes, including endothelial activation that is likely to contribute to the development of coronary ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000164201.40634.1D
更新日期:2005-05-10 00:00:00
abstract:BACKGROUND:Modeling of human arrhythmias with induced pluripotent stem cell-derived cardiomyocytes has focused on single-cell phenotypes. However, arrhythmias are the emergent properties of cells assembled into tissues, and the impact of inherited arrhythmia mutations on tissue-level properties of human heart tissue ha...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.119.039711
更新日期:2019-07-30 00:00:00
abstract:BACKGROUND:Factors predicting the occurrence of premature coronary artery disease (CAD) may not be quantitatively the same as those predicting CAD severity, particularly in women, in whom there have been few studies. METHODS AND RESULTS:To determine factors predictive of severity of CAD and of angina pectoris, we docu...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.89.5.1974
更新日期:1994-05-01 00:00:00
abstract::The Academic Research Consortium (ARC)-2 initiative revisited the clinical and angiographic end point definitions in coronary device trials, proposed in 2007, to make them more suitable for use in clinical trials that include increasingly complex lesion and patient populations and incorporate novel devices such as bio...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/CIRCULATIONAHA.117.029289
更新日期:2018-06-12 00:00:00
abstract:BACKGROUND:Right ventricular (RV) dilatation that occurs as a consequence of RV infarction is thought to produce hemodynamic instability by reducing left ventricular (LV) preload and compliance. We hypothesized that these geometric changes may also adversely affect LV systolic performance. METHODS AND RESULTS:Twelve 4...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.100.7.761
更新日期:1999-08-17 00:00:00
abstract:BACKGROUND:Right ventricular (RV) function is the major determinant for both functional capacity and survival in patients with pulmonary arterial hypertension (PAH). Despite the recognized clinical importance of preserving RV function, the subcellular mechanisms that govern the transition from a compensated to a decomp...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.120.047626
更新日期:2020-10-13 00:00:00
abstract:BACKGROUND:Cardiac-targeted expression of truncated K(v)4.2 subunit (K(v)4.2N) reduces transient outward current (I(to)) density, prolongs action potentials (APs), and enhances contractility in 3- to 4-week-old transgenic mice. By 13 to 15 weeks of age, these mice develop severely impaired cardiac function and signs of...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.0000014211.47830.4d
更新日期:2002-04-16 00:00:00
abstract:BACKGROUND:Cystic medial degeneration (CMD) is a histological abnormality that is common in the aortic diseases associated with Marfan's syndrome (MFS). Although little known about the mechanism underlying CMD, several recent reports have demonstrated that vascular smooth muscle cell (VSMC) apoptosis could play a subst...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/hc37t1.094856
更新日期:2001-09-18 00:00:00
abstract::The hypothesis tested in this study was that despite the presence of severe postischemic myocardial dysfunction ("stunning"), the extraction and subsequent intracellular washout of thallium 201 should be preserved as long as irreversible sarcolemmal membrane injury was avoided. To produce myocardial stunning, 19 open-...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.81.5.1622
更新日期:1990-05-01 00:00:00
abstract::Ventricular mural thrombi complicate many cardiac diseases. The endocardial endothelium can modulate the mechanical performance of subjacent myocardium and mediate responses to certain physiopharmacologic agents. We studied the effects of aggregating platelets on the contractile performance of isolated cardiac muscle....
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.79.6.1315
更新日期:1989-06-01 00:00:00
abstract:BACKGROUND:If drug refractoriness to paroxysmal atrial fibrillation (PAF) occurs, arrhythmia surgery that involves channelling and the exclusion of specific atrial areas can abolish atrial fibrillation. The purpose of this study was to establish the effectiveness and safety of maze III surgery to abolish PAF. METHODS ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.101.13.1559
更新日期:2000-04-04 00:00:00
abstract::Variations in the frequency of complex ventricular arrhythmias were evaluated by consecutive 24-hour long-term electrocardiographic recordings over 4 days using a two-channel recorder and computer-assisted analysis system with a weighted relative mean error of 7.5 +/ 5% (SD). Twenty patients (mean age 58 +/- 9 years ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.61.4.690
更新日期:1980-04-01 00:00:00
abstract:BACKGROUND:Despite their increasing clinical use and recent evidence that growth hormone (GH) and insulin-like growth factor-1 (IGF-1) target the heart, there has been no systematic investigation of the effects of GH and IGF-1 on the cardiovascular system. METHODS AND RESULTS:Sixty normal but growing adult female rats...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.93.4.800
更新日期:1996-02-15 00:00:00
abstract:BACKGROUND:The residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) Score is an objective measure of the degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). METHODS AND RESULTS:In the randomized PCI cohort of the SYNTAX Trial (n=903)...
journal_title:Circulation
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1161/CIRCULATIONAHA.113.001803
更新日期:2013-07-09 00:00:00
abstract:BACKGROUND:The renin-angiotensin system (RAS) is a key player in the progression of heart failure. Angiotensin-(1-7) is thought to modulate the activity of the RAS. Furthermore, this peptide may play a part in the beneficial effects of angiotensin-converting enzyme inhibitors in cardiovascular disease. We assessed the ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.0000013847.07035.b9
更新日期:2002-04-02 00:00:00
abstract:BACKGROUND:Epidemiological findings suggest an association between low-for-age birth weight and the risk to develop coronary heart diseases in adulthood. During pregnancy, an imbalance between fetal demands and supply may result in permanent alterations of neuroendocrine development in the fetus. We evaluated whether c...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.102.23.2892
更新日期:2000-12-05 00:00:00
abstract::All physicians increasingly will encounter patients who have implanted cardioverter-defibrillators (ICDs) for protection from ventricular arrhythmias. This advisory provides a concise summary relevant to the assessment and management of patients with ICDs, including those who present to primary care or emergency depar...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/01.CIR.0000149716.03295.7C
更新日期:2004-12-21 00:00:00
abstract:BACKGROUND:Ruling out acute myocardial infarction (AMI) on the basis of rapid assays for cardiac markers will allow early triage of patients and cost-effective use of available coronary care facilities. METHODS AND RESULTS:We studied the value of myoglobin, creatine kinase (CK)-MBmass, and troponin T in ruling out an ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.92.12.3401
更新日期:1995-12-15 00:00:00
abstract::Aspirin has been convincingly shown to reduce stroke and death in men with transient ischemic attacks (it may possibly be beneficial to women also), myocardial infarction and death in patients with unstable angina, thromboembolic complications associated with artificial heart valves in patients receiving oral anticoag...
journal_title:Circulation
pub_type: 临床试验,杂志文章,评审
doi:10.1161/01.cir.73.2.206
更新日期:1986-02-01 00:00:00
abstract:BACKGROUND:Congestive heart failure (CHF) in humans is associated with a marked sympathoexcitation, including an augmented muscle sympathetic nerve activity (MSNA) in intraneural multiunit recordings. In the present study, single-unit recording was used to evaluate whether the firing properties of individual muscle vas...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.100.16.1708
更新日期:1999-10-19 00:00:00