Hirulog in the treatment of unstable angina. Results of the Thrombin Inhibition in Myocardial Ischemia (TIMI) 7 trial.

Abstract:

BACKGROUND:Direct thrombin inhibitors are a new class of drugs that may offer a more effective and potentially simpler alternative to heparin. Hirulog is a synthetic peptide based on the leech-derived compound hirudin and, like hirudin, is a highly specific, direct inhibitor of free and clot-bound thrombin. METHODS AND RESULTS:TIMI 7 was a randomized, double-blind study of Hirulog, given with 325 mg/d aspirin to 410 patients with unstable angina. Patients received a constant infusion of Hirulog for 72 hours at one of four doses: 0.02 (n = 160), 0.25 (n = 81), 0.5 (n = 88), and 1.0 (n = 81) mg.kg-1.h-1. The primary efficacy end point was "unsatisfactory outcome," defined as death, nonfatal myocardial infarction (MI), rapid clinical deterioration, or recurrent ischemic pain at rest with ECG changes by 72 hours. Unsatisfactory outcome was not different among the four dose groups: 8.1%, 6.2%, 11.4%, and 6.2% (P = NS). However, the secondary end point of death or nonfatal MI through hospital discharge occurred in 10.0% of patients treated with 0.02 mg.kg-1.h-1 compared with 3.2% of patients treated with the three higher doses of Hirulog (0.25, 0.5, and 1.0 mg.kg-1.h-1, P = .008). Only 2 of 410 patients (0.5%) experienced a major hemorrhage attributed to Hirulog. CONCLUSIONS:The direct thrombin inhibitor Hirulog is a promising new antithrombotic agent that deserves further study. The results of TIMI 7 lend support to the use of an antithrombin agent with aspirin in patients with unstable angina.

journal_name

Circulation

journal_title

Circulation

authors

Fuchs J,Cannon CP

doi

10.1161/01.cir.92.4.727

subject

Has Abstract

pub_date

1995-08-15 00:00:00

pages

727-33

issue

4

eissn

0009-7322

issn

1524-4539

journal_volume

92

pub_type

临床试验,杂志文章,随机对照试验
  • Alterations in left ventricular geometry, wall stress, and ejection performance after correction of congenital aortic stenosis.

    abstract::Children with congenital aortic stenosis have "excessive" left ventricular hypertrophy with reduced resting systolic wall stress that allows for supernormal ejection performance. If aortic stenosis is uncorrected, this pattern persists until adulthood. The effect of removing the aortic pressure gradient on left ventri...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.78.6.1358

    authors: Dorn GW 2nd,Donner R,Assey ME,Spann JF Jr,Wiles HB,Carabello BA

    更新日期:1988-12-01 00:00:00

  • Simvastatin, an HMG-coenzyme A reductase inhibitor, improves endothelial function within 1 month.

    abstract:BACKGROUND:Cholesterol-lowering therapy can improve cardiovascular morbidity and mortality in patients with atherosclerosis. Although the mechanisms responsible are unclear, these benefits precede macroscopic changes in the vasculature. Emerging evidence that improvement in endothelial function may occur requires subst...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/01.cir.95.5.1126

    authors: O'Driscoll G,Green D,Taylor RR

    更新日期:1997-03-04 00:00:00

  • AMP-activated protein kinase inhibits angiotensin II-stimulated vascular smooth muscle cell proliferation.

    abstract:BACKGROUND:AMP-activated protein kinase (AMPK) is a stress-activated protein kinase that works as a metabolic sensor of cellular ATP levels. Here, we investigated whether AMPK signaling has a role in the regulation of the angiotensin II (Ang II)-induced proliferation signal in rat vascular smooth muscle cells (VSMCs). ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.CIR.0000136025.96811.76

    authors: Nagata D,Takeda R,Sata M,Satonaka H,Suzuki E,Nagano T,Hirata Y

    更新日期:2004-07-27 00:00:00

  • The evolution of chemokine release supports a bimodal mechanism of spinal cord ischemia and reperfusion injury.

    abstract:BACKGROUND:Paraplegia remains a devastating complication of thoracic aortic surgery. The mechanism of the antecedent spinal cord ischemia and reperfusion injury (IR) remains poorly described. IR involves 2 injuries, an initial ischemic insult and subsequent inflammatory amplification of the injury. This mechanism is co...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.111.080275

    authors: Smith PD,Puskas F,Meng X,Lee JH,Cleveland JC Jr,Weyant MJ,Fullerton DA,Reece TB

    更新日期:2012-09-11 00:00:00

  • Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.

    abstract:BACKGROUND:Cardiovascular disease (CVD) is the leading cause of death in the United States and is responsible for 17% of national health expenditures. As the population ages, these costs are expected to increase substantially. METHODS AND RESULTS:To prepare for future cardiovascular care needs, the American Heart Asso...

    journal_title:Circulation

    pub_type: 共识发展会议,杂志文章

    doi:10.1161/CIR.0b013e31820a55f5

    authors: Heidenreich PA,Trogdon JG,Khavjou OA,Butler J,Dracup K,Ezekowitz MD,Finkelstein EA,Hong Y,Johnston SC,Khera A,Lloyd-Jones DM,Nelson SA,Nichol G,Orenstein D,Wilson PW,Woo YJ,American Heart Association Advocacy Coordinating

    更新日期:2011-03-01 00:00:00

  • Effect of tachycardia heart failure on the restitution of left ventricular function in closed-chest dogs.

    abstract:BACKGROUND:Cardiac mechanical restitution and relaxation restitution are thought to be physiological correlates of the recovery kinetics of Ca2+ release mechanisms and sequestration capacity of the sarcoplasmic reticulum (SR). Since congestive heart failure is characterized by abnormal intracellular Ca2+ handling, we s...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.91.1.176

    authors: Prabhu SD,Freeman GL

    更新日期:1995-01-01 00:00:00

  • Effect of the ouabain-quinidine interaction on left ventricular and left atrial function in conscious dogs.

    abstract::The effect of the ouabain-quinidine interaction was examined in 10 conscious dogs. Left ventricular (LV) pressure, LV dP/dt, LV diameter and left atrial (LA) diameter were measured with high-fidelity micromanometers and sonomicrometer crystals. Ouabain, 0.025 mg/kg, significantly (p less than 0.05) increased LV dP/dt,...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.67.5.1054

    authors: Goldman S,Hager WD,Olajos M,Perrier D,Mayersohn M

    更新日期:1983-05-01 00:00:00

  • Tripling survival from sudden cardiac arrest via early defibrillation without traditional education in cardiopulmonary resuscitation.

    abstract:BACKGROUND:Early defibrillation is the most important intervention affecting survival from sudden cardiac arrest (SCA). To improve public access to early defibrillation, we established Piacenza Progetto Vita (PPV), the first system of out-of-hospital early defibrillation by first-responder volunteers. METHODS AND RESU...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.0000028148.62305.69

    authors: Capucci A,Aschieri D,Piepoli MF,Bardy GH,Iconomu E,Arvedi M

    更新日期:2002-08-27 00:00:00

  • The effect of timolol vs placebo on angina pectoris.

    abstract::The effect of timolol vs placebo on the frequency of anginal episodes, nitroglycerin consumption and exercise performance was investigated in a double-blind, randomized, crossover study in 23 patients with angina pectoris. The optimal dose of timolol (10-30 mg twice daily) for each patient was titrated by exercise stu...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/01.cir.61.1.66

    authors: Aronow WS,Turbow M,Van Camp S,Lurie M,Whittaker K

    更新日期:1980-01-01 00:00:00

  • The clinical significance of bundle branch block complicating acute myocardial infarction. 2. Indications for temporary and permanent pacemaker insertion.

    abstract::The indication for prophylactic temporary and permanent pacing during acute myocardial infarction (MI) complicated by bundle branch block is high risk of progression via a Type II pattern to second or third degree (high degree) AV block during hospitalization or follow-up. In this study, determinants of high degree AV...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.58.4.689

    authors: Hindman MC,Wagner GS,JaRo M,Atkins JM,Scheinman MM,DeSanctis RW,Hutter AH Jr,Yeatman L,Rubenfire M,Pujura C,Rubin M,Morris JJ

    更新日期:1978-10-01 00:00:00

  • Significance of chronic bifascicular block without apparent organic heart disease.

    abstract::Eighty-six of 452 patients (19%) with chronic bifascicular block were found to have no clinically apparent associated organic heart disease (OHD) and were defined as having primary conduction disease (PCD). Comparison of patients with PCD and OHD revealed a significantly lower incidence of the following clinical varia...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.60.1.33

    authors: Dhingra RC,Wyndham C,Bauernfeind R,Denes P,Wu D,Swiryn S,Rosen KM

    更新日期:1979-07-01 00:00:00

  • Exercise testing in patients with microvascular angina.

    abstract::The widespread use of exercise testing for the detection of myocardial ischemia in patients suspected of having coronary artery disease led to the detection of ischemic changes in many subjects who subsequently were found to have angiographically normal epicardial vessels--the false positive response. Such a result is...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:

    authors: Epstein SE,Cannon RO 3rd,Bonow RO

    更新日期:1991-05-01 00:00:00

  • Very long-term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults

    abstract:BACKGROUND:Several centers favor replacing a diseased native heart valve with a tissue rather than a mechanical prosthesis, even in younger adult patients. However, long-term data supporting this approach are lacking. We examined the survival implications of selecting a tissue versus a mechanical prosthesis at initial ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.106.681429

    authors: Ruel M,Chan V,Bédard P,Kulik A,Ressler L,Lam BK,Rubens FD,Goldstein W,Hendry PJ,Masters RG,Mesana TG

    更新日期:2007-09-11 00:00:00

  • Oxidative stress activates endothelial innate immunity via sterol regulatory element binding protein 2 (SREBP2) transactivation of microRNA-92a.

    abstract:BACKGROUND:Oxidative stress activates endothelial innate immunity and disrupts endothelial functions, including endothelial nitric oxide synthase-derived nitric oxide bioavailability. Here, we postulated that oxidative stress induces sterol regulatory element-binding protein 2 (SREBP2) and microRNA-92a (miR-92a), which...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.114.013675

    authors: Chen Z,Wen L,Martin M,Hsu CY,Fang L,Lin FM,Lin TY,Geary MJ,Geary GG,Zhao Y,Johnson DA,Chen JW,Lin SJ,Chien S,Huang HD,Miller YI,Huang PH,Shyy JY

    更新日期:2015-03-03 00:00:00

  • Why patients with congestive heart failure die: arrhythmias and sudden cardiac death.

    abstract::Patients with congestive heart failure have a high incidence of sudden cardiac death that is attributed to ventricular arrhythmias. The mortality rate in a group of patients with class III and IV heart failure is about 40% per year, and half of the deaths are sudden. Half of the patients with New York Heart Associatio...

    journal_title:Circulation

    pub_type: 杂志文章,评审

    doi:

    authors: Bigger JT Jr

    更新日期:1987-05-01 00:00:00

  • Reversal of global apoptosis and regional stress kinase activation by cardiac resynchronization.

    abstract:BACKGROUND:Cardiac dyssynchrony in the failing heart worsens global function and efficiency and generates regional loading disparities that may exacerbate stress-response molecular signaling and worsen cell survival. We hypothesized that cardiac resynchronization (CRT) from biventricular stimulation reverses such molec...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.107.706291

    authors: Chakir K,Daya SK,Tunin RS,Helm RH,Byrne MJ,Dimaano VL,Lardo AC,Abraham TP,Tomaselli GF,Kass DA

    更新日期:2008-03-18 00:00:00

  • Elevated matrix metalloproteinase-9 associated with stroke or cardiovascular death in patients with carotid stenosis.

    abstract:BACKGROUND:Matrix metalloproteinase-9 could exhibit an important role in the destabilization of atherosclerotic carotid plaques. We hypothesized that in patients with carotid stenosis, elevated levels of plasma matrix metalloproteinase-9 are associated with ipsilateral stroke or cardiovascular death. METHODS AND RESUL...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.105.593483

    authors: Eldrup N,Grønholdt ML,Sillesen H,Nordestgaard BG

    更新日期:2006-10-24 00:00:00

  • Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions,

    abstract::Dual antiplatelet therapy with aspirin and a thienopyridine has been shown to reduce cardiac events after coronary stenting. However, many patients and healthcare providers prematurely discontinue dual antiplatelet therapy, which greatly increases the risk of stent thrombosis, myocardial infarction, and death. This ad...

    journal_title:Circulation

    pub_type: 杂志文章,实务指引

    doi:10.1161/CIRCULATIONAHA.106.180944

    authors: Grines CL,Bonow RO,Casey DE Jr,Gardner TJ,Lockhart PB,Moliterno DJ,O'Gara P,Whitlow P,American Heart Association.,American College of Cardiology.,Society for Cardiovascular Angiography and Interventions.,American College of Surgeon

    更新日期:2007-02-13 00:00:00

  • Effects of volume loading during experimental acute pulmonary embolism.

    abstract::Volume loading is used to treat hemodynamically compromised patients with acute pulmonary embolism despite data to suggest that volume loading after embolism might cause a leftward shift of the ventricular septum with a subsequent decrease in left ventricular (LV) end-diastolic volume and stroke work. We studied 10 cl...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.80.1.178

    authors: Belenkie I,Dani R,Smith ER,Tyberg JV

    更新日期:1989-07-01 00:00:00

  • Ascorbic acid reverses endothelial vasomotor dysfunction in patients with coronary artery disease.

    abstract:BACKGROUND:In the setting of atherosclerosis, endothelial vasomotor function is abnormal. Increased oxidative stress has been implicated as one potential mechanism for this observation. We therefore hypothesized that an antioxidant, ascorbic acid, would improve endothelium-dependent arterial dilation in patients with c...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章

    doi:10.1161/01.cir.93.6.1107

    authors: Levine GN,Frei B,Koulouris SN,Gerhard MD,Keaney JF Jr,Vita JA

    更新日期:1996-03-15 00:00:00

  • Reduced mortality and strokes with off-pump coronary artery bypass grafting surgery in octogenarians.

    abstract:BACKGROUND:Off-pump coronary artery bypass surgery (OPCAB) has been revived and has gained popularity, although the exact subsets of patients who might benefit most from this technique are unknown. The aim of this retrospective study was to compare the results of coronary artery bypass grafting surgery (CABG) in octoge...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:

    authors: Demaria RG,Carrier M,Fortier S,Martineau R,Fortier A,Cartier R,Pellerin M,Hébert Y,Bouchard D,Pagé P,Perrault LP

    更新日期:2002-09-24 00:00:00

  • Wild-type and mutant HCN channels in a tandem biological-electronic cardiac pacemaker.

    abstract:BACKGROUND:Biological pacemakers (BPM) implanted in canine left bundle branch function competitively with electronic pacemakers (EPM). We hypothesized that BPM engineered with the use of mE324A mutant murine HCN2 (mHCN2) genes would improve function over mHCN2 and that BPM/EPM tandems confer advantage over either appro...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.106.617613

    authors: Bucchi A,Plotnikov AN,Shlapakova I,Danilo P Jr,Kryukova Y,Qu J,Lu Z,Liu H,Pan Z,Potapova I,KenKnight B,Girouard S,Cohen IS,Brink PR,Robinson RB,Rosen MR

    更新日期:2006-09-05 00:00:00

  • Metabolic Predictors of Incident Coronary Heart Disease in Women.

    abstract:BACKGROUND:Although metabolomic profiling offers promise for the prediction of coronary heart disease (CHD), and metabolic risk factors are more strongly associated with CHD in women than men, limited data are available for women. METHODS:We applied a liquid chromatography-tandem mass spectrometry metabolomics platfor...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1161/CIRCULATIONAHA.117.029468

    authors: Paynter NP,Balasubramanian R,Giulianini F,Wang DD,Tinker LF,Gopal S,Deik AA,Bullock K,Pierce KA,Scott J,Martínez-González MA,Estruch R,Manson JE,Cook NR,Albert CM,Clish CB,Rexrode KM

    更新日期:2018-02-20 00:00:00

  • Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device: Results From the AATAC Multicenter Randomized Trial.

    abstract:BACKGROUND:Whether catheter ablation (CA) is superior to amiodarone (AMIO) for the treatment of persistent atrial fibrillation (AF) in patients with heart failure is unknown. METHODS AND RESULTS:This was an open-label, randomized, parallel-group, multicenter study. Patients with persistent AF, dual-chamber implantable...

    journal_title:Circulation

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1161/CIRCULATIONAHA.115.019406

    authors: Di Biase L,Mohanty P,Mohanty S,Santangeli P,Trivedi C,Lakkireddy D,Reddy M,Jais P,Themistoclakis S,Dello Russo A,Casella M,Pelargonio G,Narducci ML,Schweikert R,Neuzil P,Sanchez J,Horton R,Beheiry S,Hongo R,Hao S,

    更新日期:2016-04-26 00:00:00

  • The impending crisis awaiting cardiac transplantation. Modeling a solution based on selection.

    abstract:BACKGROUND:Each month, the number of transplant candidates added to the waiting list exceeds the number of transplantations performed, and many outpatients deteriorate to require transplantation urgently. The current list of 2400 candidates and the average wait of 8 months continue to increase. METHODS AND RESULTS:To ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.89.1.450

    authors: Stevenson LW,Warner SL,Steimle AE,Fonarow GC,Hamilton MA,Moriguchi JD,Kobashigawa JA,Tillisch JH,Drinkwater DC,Laks H

    更新日期:1994-01-01 00:00:00

  • Saphenous vein grafts with multiple versus single distal targets in patients undergoing coronary artery bypass surgery: one-year graft failure and five-year outcomes from the Project of Ex-Vivo Vein Graft Engineering via Transfection (PREVENT) IV trial.

    abstract:BACKGROUND:Limited information exists on the intermediate-term graft patency and 5-year clinical outcomes of patients receiving saphenous vein grafts with multiple (m-SVG) versus single distal targets (s-SVG) during coronary artery bypass graft (CABG) surgery in the current era. METHODS AND RESULTS:We studied the asso...

    journal_title:Circulation

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1161/CIRCULATIONAHA.110.991299

    authors: Mehta RH,Ferguson TB,Lopes RD,Hafley GE,Mack MJ,Kouchoukos NT,Gibson CM,Harrington RA,Califf RM,Peterson ED,Alexander JH,Project of Ex-vivo Vein Graft Engineering via Transfection (PREVENT) IV Investigators.

    更新日期:2011-07-19 00:00:00

  • The Evolution of the Use of β-Blockers to Treat Heart Failure: A Conversation With Finn Waagstein, MD.

    abstract::Finn Waagstein was born in Copenhagen in 1938. He graduated from Aarhus University Medical School in 1964. He received his cardiology training in the Sahlgrenska University Hospital at the University of Gothenburg, Sweden. He was appointed Associate Professor in 1980, and he assisted in establishing and directing the ...

    journal_title:Circulation

    pub_type: 面试

    doi:10.1161/CIRCULATIONAHA.117.029934

    authors: Waagstein F,Rutherford JD

    更新日期:2017-09-05 00:00:00

  • Mapping of atrial activation with a noncontact, multielectrode catheter in dogs.

    abstract:BACKGROUND:Endocardial mapping of sustained arrhythmias has traditionally been performed with a roving diagnostic catheter. Although this approach is adequate for many tachyarrhythmias, it has limitations. The purpose of this study was to evaluate a novel noncontact mapping system for assessing atrial tachyarrhythmias....

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.99.14.1906

    authors: Kadish A,Hauck J,Pederson B,Beatty G,Gornick C

    更新日期:1999-04-13 00:00:00

  • Critical Role of Cytosolic DNA and Its Sensing Adaptor STING in Aortic Degeneration, Dissection, and Rupture.

    abstract:BACKGROUND:Sporadic aortic aneurysm and dissection (AAD), caused by progressive aortic smooth muscle cell (SMC) loss and extracellular matrix degradation, is a highly lethal condition. Identifying mechanisms that drive aortic degeneration is a crucial step in developing an effective pharmacologic treatment to prevent d...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.119.041460

    authors: Luo W,Wang Y,Zhang L,Ren P,Zhang C,Li Y,Azares AR,Zhang M,Guo J,Ghaghada KB,Starosolski ZA,Rajapakshe K,Coarfa C,Li Y,Chen R,Fujiwara K,Abe JI,Coselli JS,Milewicz DM,LeMaire SA,Shen YH

    更新日期:2020-01-07 00:00:00

  • Characterization of the hyperpolarization-activated current, I(f), in ventricular myocytes from human failing heart.

    abstract:BACKGROUND:Disease-associated electrophysiological alterations may contribute to the increased predisposition to arrhythmias of the hypertrophied or failing myocardium. An I(f)-like current is expressed in rat left ventricular myocytes (LVMs), its amplitude being linearly related to the severity of cardiac hypertrophy....

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.95.3.568

    authors: Cerbai E,Pino R,Porciatti F,Sani G,Toscano M,Maccherini M,Giunti G,Mugelli A

    更新日期:1997-02-04 00:00:00