Abstract:
:Although coronary thrombosis is thought to play a pivotal role in the pathogenesis of unstable angina and non-Q wave myocardial infarction and antithrombotic therapy is a mainstay in the early management of these patients, the relation between measures of systemic anticoagulation and clinical events has not been defined clearly. In the Thrombolysis in Myocardial Ischemia III trial, 1473 patients with ischemic chest pain at rest evaluated within 24 hours of symptom onset were randomized to (1) tissue plasminogen activator (TPA) or placebo and (2) an early invasive or an early conservative strategy. All patients received a full complement of anti-ischemic medication, aspirin, and continuous intravenous heparin titrated to an activated partial thromboplastin time (aPTT) of 1.5 to 2.0 times control for 72 to 96 hours. The median aPTT in all study groups exceeded the minimum threshold (45 seconds) by 24 hours and remained within the designated range during the protocol-directed heparin infusion. No differences in median aPTT values for the 72- to 96-hour study period were observed between groups (p=not significant). Median 12-hour heparin concentrations were >0.2 U/ml in all groups; however, values <0.2 U/ml were common thereafter, particularly in TPA-treated patients. Time-dependent covariate analyses failed to identify statistically significant differences in either aPTT or heparin levels between patients with in-hospital clinical events (spontaneous ischemia, myocardial infarction, or death) and those without events (p=0.27). Furthermore, early clinical events occurred in a similar percentage of patients with optimal anticoagulation (all aPTTs >60 seconds, all heparin levels>0.2 U/ml), and those with aPTTs or heparin levels below these thresholds. Aggressive (high-intensity) anticoagulation with heparin to achieve aPTTs >2.0 times control does not appear to offer additional clinical benefit to lower levels (1.5 to 2.0 times control) among patients with unstable angina and non-Q wave myocardial infarction receiving intravenous heparin and oral aspirin. Therefore, the optimal level of anticoagulation in this common clinical setting is between 45 and 60 seconds when heparin is included in the treatment strategy. Direct plasma heparin measurement does not offer an advantage to routine aPTT monitoring. The occurrence of spontaneous ischemia, myocardial infarction, and death in spite of antischemic therapy and optimal anticoagulation (as it is currently defined) with heparin supports ongoing efforts to develop more effective antithrombotic agents.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Becker RC,Cannon CP,Tracy RP,Thompson B,Bovill EG,Desvigne-Nickens P,Randall AM,Knatternud G,Braunwald Edoi
10.1016/s0002-8703(96)90519-0subject
Has Abstractpub_date
1996-03-01 00:00:00pages
421-33issue
3eissn
0002-8703issn
1097-6744pii
S0002-8703(96)90519-0journal_volume
131pub_type
临床试验,杂志文章,多中心研究,随机对照试验,评审abstract::Percutaneous coronary interventions have been performed for 20 years. Despite the success and progress of these interventions, abrupt vessel closure has been a dramatic adverse event of coronary interventions. Closure has frequently led to the major complications of death, myocardial infarction, and emergency coronary...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(97)70069-3
更新日期:1997-09-01 00:00:00
abstract:BACKGROUND:Current practice related to the management of atrial fibrillation (AF) complicating coronary artery bypass grafting (CABG) is uncertain. METHODS:We examined management of post-CABG AF in the PREVENT-IV trial, and we explored patterns of use of postoperative rhythm versus rate control and anticoagulation for...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2009.09.003
更新日期:2009-11-01 00:00:00
abstract::We evaluated electrocardiographically the acute effect of captopril in the initial treatment of malignant or severe hypertension and the findings were compared with the data obtained with diazoxide. The captopril group included seven patients treated with captopril or with a combination of diuretics. The diazoxide gro...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(83)90702-0
更新日期:1983-09-01 00:00:00
abstract:BACKGROUND:After the Mustard or Senning procedure, adults with transposition of the great arteries may have right ventricular failure and require consideration of new therapies. A 2-stage arterial switch operation (ASO) may be performed as an alternative to heart transplantation. This procedure is relatively successful...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2003.09.015
更新日期:2004-03-01 00:00:00
abstract::To evaluate the therapeutic efficacy of oral angiotensin-converting inhibition (ACE) with captopril in chronic normotensive congestive heart failure (CHF), acute and cardiocirculatory actions were determined by cardiac catheterization and forearm plethysmography, and ambulatory effects were assessed by echocardiograph...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(81)90379-3
更新日期:1981-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:The pathogenesis of human coronary artery disease (CAD) is likely to require the transcription of many different genes. We report here the differential gene expression profiling of human CAD using copy DNA (cDNA)/nylon array hybridization techniques. METHODS AND RESULTS:Human coronary arteries...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.10.025
更新日期:2005-09-01 00:00:00
abstract::To determine the frequency and significance of left ventricular wall motion abnormalities in patients without clinical evidence of myocardial infarction, we reviewed the two-dimensional echocardiograms of 252 patients who had no history or electrocardiographic evidence of myocardial infarction and who subsequently und...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90666-6
更新日期:1991-04-01 00:00:00
abstract:BACKGROUND:Although inflammation is a core element of atherogenesis and plasma levels of fibrinogen (FGB), homocysteine, and intercellular adhesion molecule-1 (ICAM-1) differ by race/ethnicity, little is known about the role of genetic polymorphisms in the FGB, methylenetetrahydrofolate reductase (MTHFR), and ICAM-1 ge...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2008.12.012
更新日期:2009-04-01 00:00:00
abstract::The development of ECG Minnesota Q-QS codes and their subsequent evolution were studied in the first 692 subjects to enter the POSCH program who had had one MI. The mean interval from MI to entry into the study was 2.2 years. Sixty-three percent of the subjects developed the most significant code with the infarction. ...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(85)90169-3
更新日期:1985-08-01 00:00:00
abstract:BACKGROUND:We compared efficacy and safety of short- (3 or 6 months) versus long-term (≥12 months) dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation, according to the presence of chronic kidney disease (CKD). METHODS:Patient-level pooled analysis was performed with 7242 patients (87.2% with ...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2017.11.013
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:Invasive coronary angiography (ICA) alone fails to accurately select patients with intermediate stenoses who should be treated by percutaneous coronary intervention (PCI). Previous studies have demonstrated the usefulness of fractional flow reserve (FFR) for identifying patients in whom deferring an intended...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2006.11.013
更新日期:2007-03-01 00:00:00
abstract::Three cases of apical left ventricular hypertrophy demonstrating a sequestered small left ventricular apical cavity with complete systolic and partial diastolic intraventricular obstruction are described. Doppler studies revealed that flow from the apical chamber is aborted during early systole with further emptying d...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90730-2
更新日期:1988-12-01 00:00:00
abstract:BACKGROUND:More than three fourths of patients with heart failure (HF) are 65 years and older, and older age is associated with worse symptoms and prognoses than is younger age. Reduced exercise capacity is a chief HF complaint and indicates poorer prognosis, especially among elderly persons, but the mechanisms underly...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2009.07.018
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:CSL112 (apolipoprotein A-I [human]) is a plasma-derived apolipoprotein A-I developed for early reduction of cardiovascular risk following an acute myocardial infarction (AMI). The safety of CSL112 among AMI subjects with moderate, stage 3 chronic kidney disease (CKD) is unknown. METHODS:CSL112_2001, a multi...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2018.11.008
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:The long-term prognostic significance of elevated cardiac markers in an undifferentiated patient population with chest pain is unknown. METHODS:Serum troponin I (cTnI), creatine kinase-MB (CK-MB), and myoglobin were measured at presentation in 951 consecutive patients evaluated in the emergency department f...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2008.06.020
更新日期:2008-11-01 00:00:00
abstract:BACKGROUND:Although the safety and cost-effectiveness of same-day discharge after uncomplicated transradial percutaneous coronary intervention (TR-PCI) is well established in Europe and Asia, such data are not available for US patients. METHODS:All patients who underwent TR-PCI at our high-volume US medical center bet...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2008.07.018
更新日期:2008-12-01 00:00:00
abstract:BACKGROUND:Peroxisome proliferator-activated receptors (PPARs) regulate transcription of genes involved in glucose uptake, lipid metabolism, and inflammation. Aleglitazar is a potent dual PPAR agonist with insulin-sensitizing and glucose-lowering actions and favorable effects on lipid profiles and biomarkers of cardiov...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2013.05.013
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Observational studies have shown apparently lower ischemic coronary disease risk in postmenopausal women receiving hormone replacement therapy (HRT). However, several recent studies have shown an increase in ischemic cardiac events when HRT is initiated in postmenopausal women with known coronary artery dise...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2004.10.028
更新日期:2005-09-01 00:00:00
abstract::Oxygen free radical scavengers have been found to decrease infarct size in dogs subjected to myocardial ischemia-reperfusion injury. A baboon open-chest model was used to determine if superoxide dismutase (SOD), an oxygen free radical scavenger, together with catalase would be equally effective in subhuman primates (b...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90697-8
更新日期:1993-10-01 00:00:00
abstract::The plasma concentration of atrial natriuretic polypeptide (ANP) was measured in nine patients with essential hypertension during two grades of exercise tests performed in the supine position on a bicycle ergometer. The plasma ANP concentration significantly increased from 97.0 +/- 19.2 pg/ml to 107.6 +/- 23.7 pg/ml (...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(88)90159-7
更新日期:1988-10-01 00:00:00
abstract::To determine the clinical usefulness of echocardiography in patients with anteroseptal myocardial infarction, echocardiograms were performed within 24 hours of admission on 40 patients with acute transmural anteroseptal myocardial infarction. Twenty-one patients had normal septal motion and septal systolic thickening,...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(79)90007-3
更新日期:1979-06-01 00:00:00
abstract::Acute ventricular septal rupture in the setting of acute myocardial infarction continues to present clinicians with a difficult therapeutic dilemma. The role of surgical intervention and its timing remains unresolved. A collaborative study from three institutions was undertaken to examine various clinical outcomes in ...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1016/0002-8703(88)90458-9
更新日期:1988-11-01 00:00:00
abstract:BACKGROUND:During daytime working hours, outcomes may be worse when percutaneous coronary intervention (PCI) is performed later in the day because of operator fatigue and differences in process of care. METHODS:Using the APPROACH database, we analyzed 2,492 consecutive nonurgent PCI procedures performed during working...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2010.03.010
更新日期:2010-06-01 00:00:00
abstract::The detection of premature ectopic beats coinciding with the T-wave of the antecedent beat is important for patient monitoring. In the method described here, the difficulties of direct measurement of QT time are avoided by evaluating the changes of QT time according to heart rate by use of a diode function generator. ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90191-x
更新日期:1975-06-01 00:00:00
abstract::There has been considerable debate regarding the value of programmed electrical stimulation in patients who present with asymptomatic, or minimally symptomatic, nonsustained VT. Unfortunately, there has never been a sufficiently large study of an untreated group of patients to make any sense of the issue. We culled th...
journal_title:American heart journal
pub_type: 杂志文章,meta分析
doi:10.1016/0002-8703(92)90664-h
更新日期:1992-02-01 00:00:00
abstract:BACKGROUND:Lowering low-density lipoprotein cholesterol (LDL-C) by statins is a key strategy for secondary prevention of acute coronary syndrome (ACS). However, few studies have examined prehospital statin use and admission LDL-C levels in ACS patients with history of myocardial infarction (MI) or revascularization. Th...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2019.02.019
更新日期:2019-06-01 00:00:00
abstract:BACKGROUND:Achieving a therapeutic international normalized ratio (INR) before hospital discharge is an important inpatient goal for patients undergoing mechanical cardiac valve replacement (MCVR). The use of clinical algorithms has reduced the time to achieve therapeutic INR (TTI) with warfarin therapy. Whether TTI pr...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2017.02.011
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:Low-dose (25mg), slow infusion (6hours) of tissue-type plasminogen activator (t-PA) with repetition as needed has been shown to provide effective and safer thrombolysis in patients with prosthetic valve thrombosis (PVT). Further prolonging the infusion time may be rational with regard to reducing complicatio...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/j.ahj.2015.04.025
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:Protocols incorporating high-sensitivity troponin to guide decision making in the disposition of patients with suspected acute coronary syndromes (ACS) in the emergency department have received a lot of attention. Traditionally, patients with chest pain have required long periods of observation in emergency ...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2017.05.004
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a recently recognized condition where biomarkers and prognosis are less well studied than in MI with obstructive coronary artery disease (MI-CAD). We therefore aimed to investigate the one-year prognostic value of high-sensitivity ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2018.03.005
更新日期:2018-06-01 00:00:00