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 Cardioljournal_title
Journal of the American College of Cardiologyauthors
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 MAdoi
10.1016/j.jacc.2003.12.059subject
Has Abstractpub_date
2004-07-21 00:00:00pages
287-96issue
2eissn
0735-1097issn
1558-3597pii
S0735109704008757journal_volume
44pub_type
临床试验,杂志文章,多中心研究,随机对照试验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
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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
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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
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doi:10.1016/s0735-1097(01)01764-8
更新日期:2002-02-06 00:00:00
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
更新日期:1987-04-01 00:00:00
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...
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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
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更新日期:2012-05-15 00:00:00
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
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doi:10.1016/j.jacc.2003.07.048
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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
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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
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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
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(99)00068-6
更新日期:1999-05-01 00:00:00
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journal_title:Journal of the American College of Cardiology
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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
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journal_title:Journal of the American College of Cardiology
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doi:10.1016/0735-1097(92)90100-2
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journal_title:Journal of the American College of Cardiology
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doi:10.1016/j.jacc.2005.09.074
更新日期:2006-03-21 00:00:00
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doi:10.1016/0735-1097(95)00412-2
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journal_title:Journal of the American College of Cardiology
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doi:10.1016/s0735-1097(97)00378-1
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journal_title:Journal of the American College of Cardiology
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更新日期:2007-10-09 00:00:00
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journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
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journal_title:Journal of the American College of Cardiology
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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
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更新日期:2010-09-14 00:00:00
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