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.

Abstract:

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.

journal_name

J Am Coll Cardiol

authors

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

doi

10.1016/j.jacc.2003.12.059

subject

Has Abstract

pub_date

2004-07-21 00:00:00

pages

287-96

issue

2

eissn

0735-1097

issn

1558-3597

pii

S0735109704008757

journal_volume

44

pub_type

临床试验,杂志文章,多中心研究,随机对照试验
  • Cocaine-induced alterations in prostaglandin production in rabbit aorta.

    abstract::To determine if alterations in endothelial prostaglandin production occur after long-term cocaine use, 26 New Zealand White rabbits were randomized to a low fat diet with (n = 12) or without (n = 14) daily intravenous cocaine (2 mg/kg body weight). Rabbits were killed at 6 or 12 weeks. Segments of aorta were examined ...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(10)80295-5

    authors: Eichhorn EJ,Demian SE,Alvarez LG,Willard JE,Molina S,Bartula LL,Prince MD,Inman LR,Grayburn PA,Myers SI

    更新日期:1992-03-01 00:00:00

  • Remote-control percutaneous coronary interventions: concept, validation, and first-in-humans pilot clinical trial.

    abstract:OBJECTIVES:This study was designed to assess the feasibility and safety of a Remote Navigation System (RNS, NaviCath, Haifa, Israel) in which the angioplasty guidewire, the balloon, and the stent are navigated via a computerized system. BACKGROUND:Percutaneous coronary interventions (PCIs) are manually performed under...

    journal_title:Journal of the American College of Cardiology

    pub_type: 临床试验,杂志文章

    doi:10.1016/j.jacc.2005.09.024

    authors: Beyar R,Gruberg L,Deleanu D,Roguin A,Almagor Y,Cohen S,Kumar G,Wenderow T

    更新日期:2006-01-17 00:00:00

  • Intracardiac phased-array imaging: methods and initial clinical experience with high resolution, under blood visualization: initial experience with intracardiac phased-array ultrasound.

    abstract:OBJECTIVES:This study was designed to test the feasibility of high-resolution phased-array intracardiac imaging. BACKGROUND:Intracardiac echocardiographic imaging of the heart during interventional electrophysiologic (EP) procedures has been limited by inadequate ultrasound penetration and absence of Doppler hemodynam...

    journal_title:Journal of the American College of Cardiology

    pub_type: 临床试验,杂志文章

    doi:10.1016/s0735-1097(01)01764-8

    authors: Packer DL,Stevens CL,Curley MG,Bruce CJ,Miller FA,Khandheria BK,Oh JK,Sinak LJ,Seward JB

    更新日期:2002-02-06 00:00:00

  • Echocardiographic contrast agents: effect of microbubbles and carrier solutions on left ventricular contractility.

    abstract::Recently, there has been a resurgence of interest in the use of contrast-enhanced echocardiography as a means of noninvasively assessing myocardial perfusion. However, if injections of echocardiographic contrast agents are to be used for this purpose it is essential that they are not intrinsically toxic to the heart. ...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(87)80250-4

    authors: Lang RM,Borow KM,Neumann A,Feinstein SB

    更新日期:1987-04-01 00:00:00

  • Prediction of risk for first age-related cardiovascular events in an elderly population: the incremental value of echocardiography.

    abstract:OBJECTIVES:We sought to determine if echocardiography enhances prediction of first age-related cardiovascular events. BACKGROUND:Whether echocardiographic assessment improves risk stratification for first cardiovascular events is not well known. METHODS:This retrospective cohort study included randomly selected resid...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(03)00943-4

    authors: Tsang TS,Barnes ME,Gersh BJ,Takemoto Y,Rosales AG,Bailey KR,Seward JB

    更新日期:2003-10-01 00:00:00

  • Ventricular arrhythmias in the absence of structural heart disease.

    abstract::Ventricular arrhythmia (VA) in structurally normal hearts can be broadly considered under non-life-threatening monomorphic and life-threatening polymorphic rhythms. Monomorphic VA is classified on the basis of site of origin in the heart, and the most common areas are the ventricular outflow tracts and left ventricula...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章,评审

    doi:10.1016/j.jacc.2012.01.036

    authors: Prystowsky EN,Padanilam BJ,Joshi S,Fogel RI

    更新日期:2012-05-15 00:00:00

  • Intravascular ultrasound molecular imaging of atheroma components in vivo.

    abstract:OBJECTIVES:Our purpose was to quantitate and confirm specific echogenic immunoliposome (ELIP) atheroma component enhancement in vivo. BACKGROUND:Targeted ELIPs for ultrasonic detection and staging of active molecular components of endothelium and atheroma have been developed. METHODS:In Yucatan miniswine, the endothe...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/j.jacc.2003.07.048

    authors: Hamilton AJ,Huang SL,Warnick D,Rabbat M,Kane B,Nagaraj A,Klegerman M,McPherson DD

    更新日期:2004-02-04 00:00:00

  • Russek Lecture. Must cardiology lose its heart?

    abstract::Regulations and restrictions imposed by external agencies are forcing cardiologists into an unnatural self-protective and defensive posture against their patients. The key to breaking the pattern of mutual skepticism and mistrust lies in returning the focus to its rightful place: the patients' needs. Thus, payment sys...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/0735-1097(92)90630-6

    authors: Gorlin R

    更新日期:1992-06-01 00:00:00

  • Late systolic click from isolated tricuspid valve prolapse simulating paradoxical splitting of the second heart sound.

    abstract::A 72 year old woman was thought to have a paradoxically split second heart sound. Echocardiography with simultaneous phonocardiography revealed a late systolic click resulting from isolated tricuspid valve prolapse. Respiratory variation of the click in relation to the second heart sound resulted in an auscultatory ph...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(85)80414-9

    authors: Farrar MW,Engel PJ,Eppert D,Plummer S

    更新日期:1985-03-01 00:00:00

  • Right coronary artery-pulmonary artery arteriovenous fistula secondary to open heart surgery.

    abstract::A patient is described who underwent atrial septal defect repair at age 12 and presented 16 years later with angina. Coronary angiography revealed a right coronary artery to pulmonary artery fistula that had developed at the site of the previous thoracotomy. This is the first report of an acquired fistula of this type...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(85)80509-x

    authors: Rothschild AH,Adatepe MH,Magovern GJ,Rothschild MA,Joyner CR

    更新日期:1985-10-01 00:00:00

  • Mapping of regional myocardial strain and work during ventricular pacing: experimental study using magnetic resonance imaging tagging.

    abstract:OBJECTIVES:The purpose of this study was to determine the spatial distribution of myocardial function (myofiber shortening and work) within the left ventricular (LV) wall during ventricular pacing. BACKGROUND:Asynchronous electrical activation, as induced by ventricular pacing, causes various abnormalities in LV funct...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(99)00068-6

    authors: Prinzen FW,Hunter WC,Wyman BT,McVeigh ER

    更新日期:1999-05-01 00:00:00

  • Association of Microvesicles With Graft Patency in Patients Undergoing CABG Surgery.

    abstract:BACKGROUND:Graft patency is one of the major determinants of long-term outcome following coronary artery bypass graft surgery (CABG). Biomarkers, if indicative of the underlying pathophysiological mechanisms, would suggest strategies to limit graft failure. The prognostic value of microvesicles (MVs) for midterm graft ...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/j.jacc.2020.03.073

    authors: Camera M,Brambilla M,Canzano P,Cavallotti L,Parolari A,Tedesco CC,Zara C,Rossetti L,Tremoli E

    更新日期:2020-06-09 00:00:00

  • Racial differences in cardiac adaptation to essential hypertension determined by echocardiographic indexes.

    abstract::Epidemiologic data point to racial differences in cardiac adaptation to hypertension. In this study, echocardiography and measurement of systemic hemodynamics were performed in 30 black and 30 white patients with untreated essential hypertension. Each black patient was matched with a white patient for age, sex and mea...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(83)80150-8

    authors: Dunn FG,Oigman W,Sungaard-Riise K,Messerli FH,Ventura H,Reisin E,Frohlich ED

    更新日期:1983-05-01 00:00:00

  • Balloon pulmonary valvuloplasty in infants: a quantitative analysis of pulmonary valve-anulus-trunk structure.

    abstract:OBJECTIVES:The present study was designed to establish possible predictors of unfavorable outcome in infants with pulmonary valve stenosis. BACKGROUND:Balloon pulmonary valvuloplasty is the treatment of choice for typical pulmonary valve stenosis. Patients with dysplastic valves may be less suitable candidates for thi...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/0735-1097(92)90100-2

    authors: Cazzaniga M,Vagnola O,Alday L,Spillman A,Sciegata A,Faella H,Kurlat I

    更新日期:1992-08-01 00:00:00

  • Cardioprotective medication is associated with improved survival in patients with peripheral arterial disease.

    abstract:OBJECTIVES:We sought to investigate the effect of cardiac medication on long-term mortality in patients with peripheral arterial disease (PAD). BACKGROUND:Peripheral arterial disease is associated with increased cardiovascular morbidity and mortality. Treatment guidelines recommend aggressive management of risk factor...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/j.jacc.2005.09.074

    authors: Feringa HH,van Waning VH,Bax JJ,Elhendy A,Boersma E,Schouten O,Galal W,Vidakovic RV,Tangelder MJ,Poldermans D

    更新日期:2006-03-21 00:00:00

  • Activation of adenosine receptors before ischemia enhances tolerance against myocardial stunning in the rabbit heart.

    abstract:OBJECTIVES:This study examined whether stimulation of adenosine receptors before ischemia enhances myocardial resistance to stunning in vivo. BACKGROUND:We previously demonstrated the attenuation of myocardial stunning by ischemic preconditioning through adenosine receptor activation in rabbits. METHODS:1) To confirm...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/0735-1097(95)00412-2

    authors: Ogawa T,Miura T,Shimamoto K,Iimura O

    更新日期:1996-01-01 00:00:00

  • Gender-related differences in the central arterial pressure waveform.

    abstract:OBJECTIVES:This study investigated the effect of age and gender on central arterial hemodynamic variables derived from noninvasive tonometric carotid pressure waveforms. BACKGROUND:Women have a greater age-related increase in left ventricular (LV) mass than do men and are more likely to experience symptomatic heart fa...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(97)00378-1

    authors: Hayward CS,Kelly RP

    更新日期:1997-12-01 00:00:00

  • A founder mutation of the potassium channel KCNQ1 in long QT syndrome: implications for estimation of disease prevalence and molecular diagnostics.

    abstract:OBJECTIVES:We took advantage of the genetic isolate of Finns to characterize a common long QT syndrome (LQTS) mutation, and to estimate the prevalence of LQTS. BACKGROUND:The LQTS is caused by mutations in different ion channel genes, which vary in their molecular nature from family to family. METHODS:The potassium c...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(00)01124-4

    authors: Piippo K,Swan H,Pasternack M,Chapman H,Paavonen K,Viitasalo M,Toivonen L,Kontula K

    更新日期:2001-02-01 00:00:00

  • High prevalence of atrial fibrosis in patients with dilated cardiomyopathy.

    abstract:OBJECTIVES:We examined the extent of fibrotic changes in the left atrium of cardiomyopathic human hearts and investigated the relation of mechanical overload caused by left ventricular dysfunction to fibrosis of the left atrium. BACKGROUND:Left atrial dysfunction in dilated cardiomyopathy may contribute to progression...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/0735-1097(94)00529-y

    authors: Ohtani K,Yutani C,Nagata S,Koretsune Y,Hori M,Kamada T

    更新日期:1995-04-01 00:00:00

  • Role of atrial electrophysiology and autonomic nervous system in patients with supraventricular tachycardia and paroxysmal atrial fibrillation.

    abstract:OBJECTIVES:The purposes of this study were to evaluate the atrial electrophysiology and autonomic nervous system in patients who had paroxysmal supraventricular tachycardia (PSVT) associated with paroxysmal atrial fibrillation (PAF). BACKGROUND:PAF frequently appeared in patients with PSVT. However, the critical deter...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(98)00305-2

    authors: Chen YJ,Chen SA,Tai CT,Wen ZC,Feng AN,Ding YA,Chang MS

    更新日期:1998-09-01 00:00:00

  • Restrictive right ventricular physiology: its presence and symptomatic contribution in patients with pulmonary valvular stenosis.

    abstract:OBJECTIVES:The aim of this study was to examine whether restrictive right ventricular (RV) physiology (the presence of antegrade pulmonary arterial flow in late diastole) occurred in patients with moderate to severe isolated pulmonary valvular stenosis (PVS) and to estimate its prevalence and relationship to RV functio...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/j.jacc.2007.06.042

    authors: Lam YY,Kaya MG,Goktekin O,Gatzoulis MA,Li W,Henein MY

    更新日期:2007-10-09 00:00:00

  • Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model.

    abstract:OBJECTIVES:The goal of this study was to assess mechanisms underlying atrial fibrillation (AF) promotion by exercise training in an animal model. BACKGROUND:High-level exercise training promotes AF, but the underlying mechanisms are unclear. METHODS:AF susceptibility was assessed by programmed stimulation in rats aft...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/j.jacc.2013.01.091

    authors: Guasch E,Benito B,Qi X,Cifelli C,Naud P,Shi Y,Mighiu A,Tardif JC,Tadevosyan A,Chen Y,Gillis MA,Iwasaki YK,Dobrev D,Mont L,Heximer S,Nattel S

    更新日期:2013-07-02 00:00:00

  • Expression profiling of cardiac genes in human hypertrophic cardiomyopathy: insight into the pathogenesis of phenotypes.

    abstract:OBJECTIVES:The goal of this study was to identify genes upregulated in the heart in human patients with hypertrophic cardiomyopathy (HCM). BACKGROUND:Hypertrophic cardiomyopathy is a genetic disease caused by mutations in contractile sarcomeric proteins. The molecular basis of diverse clinical and pathologic phenotype...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(01)01509-1

    authors: Lim DS,Roberts R,Marian AJ

    更新日期:2001-10-01 00:00:00

  • Pericardial thickness measured with transesophageal echocardiography: feasibility and potential clinical usefulness.

    abstract:OBJECTIVES:This study assessed the reliability of transesophageal echocardiographic measurements of pericardial thickness and the potential diagnostic usefulness of this technique. BACKGROUND:Transthoracic echocardiography cannot reliably detect thickened pericardium. The superior resolution achieved with transesophag...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(97)82756-8

    authors: Ling LH,Oh JK,Tei C,Click RL,Breen JF,Seward JB,Tajik AJ

    更新日期:1997-05-01 00:00:00

  • Changes of right ventricular size and function in neonates after valvotomy for pulmonary atresia or critical pulmonary stenosis and intact ventricular septum.

    abstract::Right ventricular end-diastolic and stroke volumes were calculated from orthogonal subcostal echocardiographic images in 24 neonates (mean weight +/- SD 3.4 +/- 0.4 kg) with pulmonary atresia (n = 18) or critical pulmonary stenosis (n = 6) and intact ventricular septum before and at an average of 5 days and then 19 da...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/0735-1097(92)90289-y

    authors: Schmidt KG,Cloez JL,Silverman NH

    更新日期:1992-04-01 00:00:00

  • Do cardiologists do it better?

    abstract::Pressure to lower the cost of health care delivery has fostered widespread efforts to limit patients' access to specialists such as cardiologists. However, there is concern that diminished specialist involvement may lead to poorer patient outcomes for specific clinical conditions. As part of a state-sponsored effort t...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/s0735-1097(96)00528-1

    authors: Nash IS,Nash DB,Fuster V

    更新日期:1997-03-01 00:00:00

  • Endothelium-dependent pulmonary artery responses in chronic heart failure: influence of pulmonary hypertension.

    abstract:OBJECTIVES:The purpose of this study was to determine whether pulmonary artery responses to acetylcholine are abnormal in patients with chronic heart failure. BACKGROUND:Defective pulmonary artery endothelium-dependent responses have been observed in chronic heart failure models in animals. However, pulmonary artery e...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/0735-1097(93)90552-c

    authors: Porter TR,Taylor DO,Cycan A,Fields J,Bagley CW,Pandian NG,Mohanty PK

    更新日期:1993-11-01 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

    doi:10.1016/s0735-1097(84)80278-8

    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

  • The value of defibrillator electrograms for recognition of clinical ventricular tachycardias and for pace mapping of post-infarction ventricular tachycardia.

    abstract:OBJECTIVES:The purpose of this study was to assess the value of implantable cardioverter-defibrillator (ICD) electrograms (EGMs) in identifying clinically documented ventricular tachycardias (VTs). BACKGROUND:Twelve-lead electrocardiograms (ECG) of spontaneous VT often are not available in patients referred for cathet...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/j.jacc.2010.04.043

    authors: Yoshida K,Liu TY,Scott C,Hero A,Yokokawa M,Gupta S,Good E,Morady F,Bogun F

    更新日期:2010-09-14 00:00:00

  • Electrophysiologic consequences of the arterial switch repair of d-transposition of the great arteries.

    abstract::Electrophysiologic studies were performed at 12.7 +/- 4 months postoperatively in 20 patients who had the arterial switch repair at 1 to 120 days (mean 13 +/- 26 [SD]) for d-transposition of the great arteries. Preoperative electrocardiograms (ECGs) at rest revealed an ectopic atrial rhythm in one patient. Postoperati...

    journal_title:Journal of the American College of Cardiology

    pub_type: 杂志文章

    doi:10.1016/0735-1097(88)90379-8

    authors: Vetter VL,Tanner CS

    更新日期:1988-07-01 00:00:00