A randomized trial of rescue angioplasty versus a conservative approach for failed fibrinolysis in ST-segment elevation myocardial infarction: the Middlesbrough Early Revascularization to Limit INfarction (MERLIN) trial.


OBJECTIVES:We sought to compare emergency coronary angiography with or without rescue percutaneous coronary intervention (PCI) with conservative treatment in patients with failed fibrinolysis complicating ST-segment elevation myocardial infarction (STEMI). BACKGROUND:Most patients with STEMI receive fibrinolytic therapy and aspirin. The management of failed fibrinolysis is unclear. METHODS:A total of 307 patients with STEMI and failed fibrinolysis were randomized to emergency coronary angiography with or without rescue PCI or conservative treatment. RESULTS:Thirty-day all-cause mortality was similar in the rescue and conservative groups (9.8% vs. 11%, p = 0.7, risk difference [RD] 1.2%, 95% confidence interval [CI] -5.8 to 8.3). The composite secondary end point of death/re-infarction/stroke/subsequent revascularization/heart failure occurred less frequently in the rescue group (37.3% vs. 50%, p = 0.02, RD 12.7%, 95% CI 1.6 to 23.5), driven by less subsequent revascularization (6.5% vs. 20.1%, p < 0.01, RD 13.6%, 95% CI 6.2 to 21.4). Re-infarction and clinical heart failure were less common in the rescue group (7.2% vs. 10.4%, p = 0.3, RD 3.2%, 95% CI -3.3 to 9.9; and 24.2% vs. 29.2%, p = 0.3, RD 5.7%, 95% CI -4.3 to 15.6, respectively). Strokes and transfusions were more common in the rescue group (4.6% vs. 0.6%, p = 0.03, RD 3.9%, 95% CI 0.5 to 8.6; and 11.1% vs. 1.3%, p < 0.001, RD 9.8%, 95% CI 4.9 to 19.9, respectively). Left ventricular function at 30 days was the same in the two groups. CONCLUSIONS:Rescue angioplasty did not improve survival by 30 days, but improved event-free survival, almost completely due to a reduction in subsequent revascularization. Rescue angioplasty was associated with more strokes and more transfusions and did not result in preservation of left ventricular systolic function at 30 days.


J Am Coll Cardiol


Sutton AG,Campbell PG,Graham R,Price DJ,Gray JC,Grech ED,Hall JA,Harcombe AA,Wright RA,Smith RH,Murphy JJ,Shyam-Sundar A,Stewart MJ,Davies A,Linker NJ,de Belder MA




Has Abstract


2004-07-21 00:00:00














  • Correlation among right ventricular preload, afterload and ejection fraction in mitral valve disease: radionuclide, echocardiographic and hemodynamic evaluation.

    abstract::The relation among right ventricular preload, afterload and ejection fraction in patients with mitral valve disease has not been well elucidated. In this study, measurements were made of intracardiac pressures and forward cardiac output during cardiac catheterization (n = 43), the ejection fraction by radionuclide ang...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Iskandrian AS,Hakki AH,Ren JF,Kotler MN,Mintz GS,Ross J,Kane SA

    更新日期:1984-06-01 00:00:00

  • Ultrastructural findings in endomyocardial biopsy of patients with Kearns-Sayre syndrome.

    abstract::Kearns-Sayre syndrome is clinically defined by progressive external ophthalmoplegia, atypical retinitis pigmentosa and the potential occurrence of complete atrioventricular (AV) block. Right septal endomyocardial biopsy specimens from nine patients (four men and five women with a mean [+/- SD] [corrected] age of 36.3 ...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Schwartzkopff B,Frenzel H,Breithardt G,Deckert M,Lösse B,Toyka KV,Borggrefe M,Hort W

    更新日期:1988-12-01 00:00:00

  • Predictive factors for development of the no-reflow phenomenon in patients with reperfused anterior wall acute myocardial infarction.

    abstract:OBJECTIVES:We sought to elucidate the clinical factors related to the development of no-reflow phenomenon after successful coronary reperfusion in patients with an acute myocardial infarction (AMI). BACKGROUND:Myocardial contrast echocardiography revealed that the no-reflow phenomenon is observed in some patients with...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Iwakura K,Ito H,Kawano S,Shintani Y,Yamamoto K,Kato A,Ikushima M,Tanaka K,Kitakaze M,Hori M,Higashino Y,Fujii K

    更新日期:2001-08-01 00:00:00

  • Effect of nifedipine on recurrent stenosis after percutaneous transluminal coronary angioplasty.

    abstract::This double-blind, randomized study evaluated the effect of nifedipine on restenosis after coronary angioplasty. Two hundred forty-one patients with dilation of 271 coronary sites were randomized at the time of hospital discharge to receive nifedipine, 10 mg (123 patients), or placebo (118 patients) four times daily f...

    journal_title:Journal of the American College of Cardiology

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Whitworth HB,Roubin GS,Hollman J,Meier B,Leimgruber PP,Douglas JS Jr,King SB 3rd,Gruentzig AR

    更新日期:1986-12-01 00:00:00

  • Dynamic change in mitral regurgitant orifice area: comparison of color Doppler echocardiographic and electromagnetic flowmeter-based methods in a chronic animal model.

    abstract:OBJECTIVES:The aim of the present study was to investigate dynamic changes in the mitral regurgitant orifice using electromagnetic flow probes and flowmeters and the color Doppler flow convergence method. BACKGROUND:Methods for determining mitral regurgitant orifice areas have been described using flow convergence ima...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Shiota T,Jones M,Teien DE,Yamada I,Passafini A,Ge S,Sahn DJ

    更新日期:1995-08-01 00:00:00

  • Local intracoronary administration of antisense oligonucleotide against c-myc for the prevention of in-stent restenosis: results of the randomized investigation by the Thoraxcenter of antisense DNA using local delivery and IVUS after coronary stenting (IT

    abstract:OBJECTIVE:This study was designed to determine whether antisense oligodeoxynucleotides (ODN) directed against the nuclear proto-oncogene c-myc could inhibit restenosis when given by local delivery immediately after coronary stent implantation. BACKGROUND:Failure of conventional pharmacologic therapies to reduce the in...

    journal_title:Journal of the American College of Cardiology

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Kutryk MJ,Foley DP,van den Brand M,Hamburger JN,van der Giessen WJ,deFeyter PJ,Bruining N,Sabate M,Serruys PW,ITALICS Trial.

    更新日期:2002-01-16 00:00:00

  • The association of differing measures of overweight and obesity with prevalent atherosclerosis: the Dallas Heart Study.

    abstract:OBJECTIVES:This study sought to evaluate the associations between different measures of obesity and prevalent atherosclerosis in a large population-based cohort. BACKGROUND:Although obesity is associated with cardiovascular mortality, it is unclear whether this relationship is mediated by increased atherosclerotic bur...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: See R,Abdullah SM,McGuire DK,Khera A,Patel MJ,Lindsey JB,Grundy SM,de Lemos JA

    更新日期:2007-08-21 00:00:00

  • Sitting Time, Physical Activity, and Risk of Mortality in Adults.

    abstract:BACKGROUND:It is unclear what level of moderate to vigorous intensity physical activity (MVPA) offsets the health risks of sitting. OBJECTIVES:The purpose of this study was to examine the joint and stratified associations of sitting and MVPA with all-cause and cardiovascular disease (CVD) mortality, and to estimate th...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Stamatakis E,Gale J,Bauman A,Ekelund U,Hamer M,Ding D

    更新日期:2019-04-30 00:00:00

  • Syncope: therapeutic approaches.

    abstract::Syncope is a common clinical problem characterized by transient, spontaneously self-terminating loss of consciousness with complete and prompt recovery; the cause is insufficiency of cerebral oxygen/nutrient supply most often due to a transient fall of systemic arterial pressure to levels below those tolerated by cere...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章,评审


    authors: Benditt DG,Nguyen JT

    更新日期:2009-05-12 00:00:00

  • Incretin-Based Therapy for Diabetes: What a Cardiologist Needs to Know.

    abstract::Incretin-based therapies are effective glucose-lowering drugs that have an increasing role in the treatment of type 2 diabetes because of their efficacy, safety, and ease of use. Both glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors are commonly used for glycemic control as adjuncts to m...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章,评审


    authors: Waldrop G,Zhong J,Peters M,Rajagopalan S

    更新日期:2016-03-29 00:00:00

  • The QT interval is associated with incident cardiovascular events: the MESA study.

    abstract:BACKGROUND:Prolonged heart rate-corrected QT interval on electrocardiograms (ECGs) is associated with increased risk of myocardial infarction and cardiovascular disease (CVD)-related deaths in patients with prevalent coronary heart disease. OBJECTIVES:This study sought to examine the prognostic association between the...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Beinart R,Zhang Y,Lima JA,Bluemke DA,Soliman EZ,Heckbert SR,Post WS,Guallar E,Nazarian S

    更新日期:2014-11-18 00:00:00

  • Therapeutic update: non-selective beta- and alpha-adrenergic blockade in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure.

    abstract::Patients with chronic heart failure (CHF) have a resting restrictive ventilatory defect. Any type of exercise requires patients with CHF to markedly increase their minute ventilation. Patients with chronic obstructive pulmonary disease (COPD) have airflow obstruction that leads to dynamic lung hyperinflation and reduc...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章,评审


    authors: Sirak TE,Jelic S,Le Jemtel TH

    更新日期:2004-08-04 00:00:00

  • Regional left atrial stasis during atrial fibrillation and flutter: determinants and relation to stroke.

    abstract:OBJECTIVES:This study sought to 1) determine the location of left atrial stasis during atrial arrhythmia; 2) define the degree of stasis associated with significant risk of stroke; and 3) identify clinical or transthoracic echocardiographic data useful for predicting left atrial stasis. BACKGROUND:Prior studies sugges...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Shively BK,Gelgand EA,Crawford MH

    更新日期:1996-06-01 00:00:00

  • CD40 ligand enhances monocyte tissue factor expression and thrombin generation via oxidative stress in patients with hypercholesterolemia.

    abstract:OBJECTIVES:We tested the hypothesis that CD40 ligand (CD40L) induces a prothrombotic state by enhancing oxidative stress. BACKGROUND:Patients with hypercholesterolemia show an ongoing prothrombotic state, but the underlying mechanism is still unclear. METHODS:Circulating levels of the soluble form of CD40L (sCD40L), ...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Sanguigni V,Ferro D,Pignatelli P,Del Ben M,Nadia T,Saliola M,Sorge R,Violi F

    更新日期:2005-01-04 00:00:00

  • Efficacy of propafenone in Wolff-Parkinson-White syndrome: electrophysiologic findings and long-term follow-up.

    abstract::The efficacy and safety of intravenous propafenone was studied in 10 patients with Wolff-Parkinson-White syndrome and in 2 patients with a concealed accessory pathway. During electrophysiologic study, the effect of propafenone on the effective refractory period of the accessory pathway was determined, as well as its e...

    journal_title:Journal of the American College of Cardiology

    pub_type: 临床试验,杂志文章


    authors: Ludmer PL,McGowan NE,Antman EM,Friedman PL

    更新日期:1987-06-01 00:00:00

  • Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology.

    abstract:OBJECTIVES:This study was designed to evaluate whether calcium deposition in the coronary arteries is related to atherosclerotic plaque burden and narrowing of the arterial lumen. BACKGROUND:Many studies have recently documented the feasibility of electron beam computed tomography to detect and quantify coronary arter...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Sangiorgi G,Rumberger JA,Severson A,Edwards WD,Gregoire J,Fitzpatrick LA,Schwartz RS

    更新日期:1998-01-01 00:00:00

  • Current complications of diagnostic and therapeutic cardiac catheterization.

    abstract::Data from 2,883 cardiac catheterizations performed during an 18 month period (from July 1986 through December 1987) were analyzed to assess the current complication profile of diagnostic and therapeutic procedures. Procedures performed during the study period included 1,609 diagnostic catheterizations, 933 percutaneou...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Wyman RM,Safian RD,Portway V,Skillman JJ,McKay RG,Baim DS

    更新日期:1988-12-01 00:00:00

  • Failure of calcium channel blockers to improve ventricular relaxation in humans.

    abstract:OBJECTIVES:The objective of this study was to ascertain whether the reversal of low peak filling rates after administration of calcium channel blockers in patients with diastolic dysfunction indicates true improvement in the rate of ventricular relaxation and left ventricular end-diastolic pressure measured by invasive...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Nishimura RA,Schwartz RS,Holmes DR Jr,Tajik AJ

    更新日期:1993-01-01 00:00:00

  • Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry.

    abstract:OBJECTIVES:The objective was to define the characteristics of a real-world patient population treated with transcatheter aortic valve implantation (TAVI), regardless of technology or access route, and to evaluate their clinical outcome over the mid to long term. BACKGROUND:Although a substantial body of data exists in...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章,多中心研究


    authors: Moat NE,Ludman P,de Belder MA,Bridgewater B,Cunningham AD,Young CP,Thomas M,Kovac J,Spyt T,MacCarthy PA,Wendler O,Hildick-Smith D,Davies SW,Trivedi U,Blackman DJ,Levy RD,Brecker SJ,Baumbach A,Daniel T,Gray H,Mulle

    更新日期:2011-11-08 00:00:00

  • Relation between contractile reserve and positron emission tomographic patterns of perfusion and glucose utilization in chronic ischemic left ventricular dysfunction: implications for identification of myocardial viability.

    abstract:OBJECTIVES:This study sought to determine the incidence and extent of dobutamine-induced contractile reserve in myocardial regions characterized by classical and new positron emission tomographic (PET) patterns in patients with chronic ischemic left ventricular dysfunction. BACKGROUND:PET is considered the most accura...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Mélon PG,de Landsheere CM,Degueldre C,Peters JL,Kulbertus HE,Piérard LA

    更新日期:1997-12-01 00:00:00

  • Homocysteine hypothesis for atherothrombotic cardiovascular disease: not validated.

    abstract::Homocysteine has been implicated in promoting atherosclerotic and thrombotic vascular disease. During the last decade, the utility of homocysteine in predicting risk for atherothrombotic vascular disease has been evaluated in several observational studies in a large number of patients. These studies show that the over...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章,评审


    authors: Kaul S,Zadeh AA,Shah PK

    更新日期:2006-09-05 00:00:00

  • Persistence of restrictive left ventricular filling pattern in dilated cardiomyopathy: an ominous prognostic sign.

    abstract:OBJECTIVES:We sought to assess the prognostic implications of the evolution of restrictive left ventricular filling pattern (RFP) in dilated cardiomyopathy (DCM). BACKGROUND:Previous work has demonstrated that a RFP in DCM is associated with a poor prognosis. Few data are available on the prognostic implications of th...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Pinamonti B,Zecchin M,Di Lenarda A,Gregori D,Sinagra G,Camerini F

    更新日期:1997-03-01 00:00:00

  • Influence of cardiac motion on Doppler measurements using in vitro and in vivo models.

    abstract:OBJECTIVES:Using both in vitro and in vivo techniques, we investigated the extent to which cardiac motion alters Doppler-measured blood flow velocity and thus potentially can alter the calculation of valve areas or pressure gradients. BACKGROUND:Blood flow velocity measured by Doppler ultrasound represents the net mot...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Cao T,Shapiro SM,Bersohn MM,Liu SC,Ginzton LE

    更新日期:1993-07-01 00:00:00

  • Flow characteristics in the dilated left ventricle with thrombus: qualitative and quantitative Doppler analysis.

    abstract::In an attempt to determine whether mural thrombus in a dilated left ventricle is associated with specific flow patterns, a study was undertaken to assess qualitatively and quantitatively the flow characteristics by conventional pulsed and two-dimensional Doppler color flow examination. Forty patients with cardiomyopat...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Maze SS,Kotler MN,Parry WR

    更新日期:1989-03-15 00:00:00

  • Percutaneous transluminal coronary angioplasty in the elderly: early and long-term results.

    abstract::The immediate and long-term efficacy of coronary angioplasty in the elderly was determined by studying 752 patients greater than or equal to 65 years old and comparing patients greater than or equal to 75 years old with those 65 to 74 years old. The oldest patients were more highly symptomatic, were more likely to be ...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Thompson RC,Holmes DR Jr,Gersh BJ,Mock MB,Bailey KR

    更新日期:1991-05-01 00:00:00

  • Impact of lesion sets on mid-term results of surgical ablation procedure for atrial fibrillation.

    abstract:OBJECTIVES:The objective of this study was to evaluate the effects of different lesion sets of ablation in patients undergoing mitral surgery plus maze. BACKGROUND:The role of lesion sets on outcome after maze is poorly defined. METHODS:A total of 141 patients were prospectively followed up. Two different lesion sets...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Onorati F,Mariscalco G,Rubino AS,Serraino F,Santini F,Musazzi A,Klersy C,Sala A,Renzulli A

    更新日期:2011-02-22 00:00:00

  • Arrhythmias after the Mustard operation for transposition of the great arteries: a long-term study.

    abstract::This study presents follow-up data on 95 patients with transposition of the great arteries who underwent a Mustard intraatrial baffle operation. The patients were followed up serially by means of scalar electrocardiograms and 24 hour Holter monitoring studies. The latter study was effective in documenting abnormal rhy...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Hayes CJ,Gersony WM

    更新日期:1986-01-01 00:00:00

  • Angiotensin II inhibits the forearm vascular response to increased arterial pressure in humans.

    abstract:OBJECTIVES:This study tested the hypothesis that angiotensin II may inhibit the forearm vascular resistance response to an increase in arterial pressure in normal humans. BACKGROUND:Angiotensin II inhibits baroreflex-mediated reductions in heart rate and peripheral sympathetic activity during increases in arterial pre...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Goldsmith SR,Hasking GJ

    更新日期:1995-01-01 00:00:00

  • Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention: implications for contemporary practice.

    abstract::Advances in percutaneous coronary intervention (PCI) during the past decade have led to more widespread use of these procedures in older and sicker patients. Refinement of periprocedural antithrombotic therapy has played a particularly important role in reducing ischemic complications to very low levels in routine pra...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章,评审


    authors: Doyle BJ,Rihal CS,Gastineau DA,Holmes DR Jr

    更新日期:2009-06-02 00:00:00

  • The warm-up effect protects against ischemic left ventricular dysfunction in patients with angina.

    abstract:OBJECTIVES:The goal of this study was to investigate whether the "warm-up" effect in angina protects against ischemic left ventricular (LV) dysfunction. BACKGROUND:After exercise, patients with coronary disease demonstrate persistent myocardial dysfunction, which may represent stunning, as well as warm-up protection a...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章


    authors: Kelion AD,Webb TP,Gardner MA,Ormerod OJ,Banning AP

    更新日期:2001-03-01 00:00:00