Abstract:
:There is strong evidence that revascularization does not prevent myocardial infarction in patients with stable coronary artery disease (CAD). The anatomic basis for this counterintuitive conclusion seems to be that most myocardial infarctions occur at sites that did not previously exhibit an angiographically significant stenosis. These angiographic observations are further supported by thallium studies in stable CAD that demonstrate that the site of stress-induced ischemia is frequently not the site of subsequent myocardial infarction. Since both coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty are directed at more severe coronary stenoses, we are led to the remarkable conclusion that angiography does not identify, and consequently revascularization therapies do not treat, the lesions that lead to myocardial infarction. The pathology of coronary atherosclerosis provides the basis for understanding why revascularization does not prevent infarction: unstable lesions that cause infarction are not necessarily severely stenotic, and stenotic lesions are not necessarily unstable. In contrast to revascularization, lipid lowering reduces the rate of myocardial infarction by approximately 30% over a period of 5 years. Thus, we might postulate that lipid lowering is the more effective therapy for both prevention of acute myocardial infarction and long-term survival. The health policy and economic implications of this viewpoint, should it emerge in the management of coronary heart disease, are clearly substantial. Consequently, the relative roles of lipid-lowering therapy and revascularization, both alone and together, must now be determined. It is an idea whose time--for testing--has come.
journal_name
Circulationjournal_title
Circulationauthors
Forrester JS,Shah PKdoi
10.1161/01.cir.96.4.1360subject
Has Abstractpub_date
1997-08-19 00:00:00pages
1360-2issue
4eissn
0009-7322issn
1524-4539journal_volume
96pub_type
杂志文章相关文献
CIRCULATION文献大全abstract:BACKGROUND:Although molecular biological studies suggest a pathogenic link between enterovirus infection and dilated cardiomyopathy (DCM), the frequency of detection of enteroviral RNA is not consistently high in myocardial tissue from patients with DCM. A recent study has suggested that hepatitis C virus (HCV) may als...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.96.1.22
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:Alterations in myocardial function and systemic vascular tone are well documented in congestive heart failure (CHF), but little information is available on the effects of CHF on pulmonary vessels. We examined the mechanisms of tone regulation of canine pulmonary arteries during pacing-induced CHF. METHODS A...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.87.5.1722
更新日期:1993-05-01 00:00:00
abstract:BACKGROUND:Recently, it has been shown that stem/progenitor cells may repair damaged/lost endothelial cells in vein grafts and wire-injured arteries. In the present study, we investigated endothelial cell turnover and regeneration in apolipoprotein E (apoE)(-/-)/transgenic mice carrying LacZ genes driven by an endothel...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.107.746008
更新日期:2008-04-08 00:00:00
abstract:BACKGROUND:Women receive less evidence-based medical care than men and have higher rates of death after acute myocardial infarction (AMI). It is unclear whether efforts undertaken to improve AMI care have mitigated these sex disparities in the current era. METHODS AND RESULTS:Using the Get With the Guidelines-Coronary...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.108.789800
更新日期:2008-12-16 00:00:00
abstract:BACKGROUND:In PTCA patients with multivessel coronary artery disease, incomplete revascularization (IR) is the result of both pre-PTCA strategy and initial lesion outcome. The unique contribution of these components on long-term patient outcome is uncertain. METHODS AND RESULTS:From the Bypass Angioplasty Revasculariz...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.100.9.910
更新日期:1999-08-31 00:00:00
abstract:BACKGROUND:During heart development, the ventricular activation sequence changes from a base-to-apex to an apex-to-base pattern. We investigated the possibility of impulse propagation through remnants of atrioventricular (AV) connections in quail hearts. METHODS AND RESULTS:In 86 hearts (group A, HH30-34, n=15; group ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.106.658807
更新日期:2007-01-02 00:00:00
abstract::BACKGROUND. A pace mapping technique using body surface potential maps (BSPMs) was developed to guide the positioning of an ablation catheter at the ventricular insertion point of accessory pathways (AP) in patients with the Wolff-Parkinson-White syndrome (WPW). METHODS AND RESULTS. The study was performed on 30 WPW p...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.87.1.135
更新日期:1993-01-01 00:00:00
abstract:BACKGROUND:Higher carotid intimal-medial thickness (IMT) is associated with cardiovascular risk factors and is predictive of coronary artery disease and stroke in older adults. Carotid IMT was measured in young and middle-aged adults to determine its relationship with risk factors measured (1) in childhood, (2) current...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/hc4601.099486
更新日期:2001-12-04 00:00:00
abstract:BACKGROUND:We previously found in a pig coronary balloon injury model that vitamins C and E as well as probucol had beneficial effects on the vessel response to injury measured by morphometry These effects correlated with an inhibition in the ability to oxidize LDLs ex vivo, suggesting that the morphological response w...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.96.10.3593
更新日期:1997-11-18 00:00:00
abstract:BACKGROUND:High blood pressure (BP) is a known risk factor for mobility and cognitive impairment in older adults. This study tested the association of cumulative BP exposure from young adulthood to midlife with gait and cognitive function in midlife. Furthermore, we tested whether these associations were modified by ce...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCULATIONAHA.119.042502
更新日期:2020-03-03 00:00:00
abstract:BACKGROUND:Tetralogy of Fallot is the most common form of congenital heart disease in implantable cardioverter-defibrillator (ICD) recipients, yet little is known about the value of ICDs in this patient population. METHODS AND RESULTS:We conducted a multicenter cohort study in high-risk patients with Tetralogy of Fall...
journal_title:Circulation
pub_type: 杂志文章,多中心研究
doi:10.1161/CIRCULATIONAHA.107.726372
更新日期:2008-01-22 00:00:00
abstract:BACKGROUND:The aim of the study was to establish the influence of proximal coronary artery atheroma and smoking habit on the stimulated release of tissue plasminogen activator (tPA) from the heart. METHODS AND RESULTS:After diagnostic coronary angiography in 25 patients, the left anterior descending coronary artery (L...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/01.cir.103.15.1936
更新日期:2001-04-17 00:00:00
abstract:BACKGROUND:Although long-term lipid-lowering therapy improves endothelium-dependent vasodilatation in humans, it remains unknown whether the short-term removal of LDL per se ameliorates endothelial dysfunction. METHODS AND RESULTS:To examine the effects of a single session of LDL apheresis on endothelial function in p...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.95.1.76
更新日期:1997-01-07 00:00:00
abstract::A prospective electrocardiographic study was designed to establish baseline values for electrocardiographic measurements, with specific reference to the QT interval during infancy, and to test the "QT hypothesis" for the sudden infant death syndrome (SIDS). In this ongoing study, ECGs are recorded on the fourth day of...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.66.3.496
更新日期:1982-09-01 00:00:00
abstract:BACKGROUND:It was the aim of this study to assess the long-term effects of physical exercise and low-fat diet on the progression of coronary artery disease. At the beginning of the study, 113 male patients with coronary artery disease were randomized to an intervention group (n=56) or a control group (n=57); 90 patient...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.96.8.2534
更新日期:1997-10-21 00:00:00
abstract:BACKGROUND:The synthetic catecholamine dobutamine increases stroke volume in normal subjects and in patients with congestive heart failure. In addition to its direct influence on myocardial contractility, dobutamine may significantly modulate vascular tone because of its alpha- and beta-adrenergic agonist activity. ME...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.84.3.1210
更新日期:1991-09-01 00:00:00
abstract:BACKGROUND:Doxycycline has been shown to effectively inhibit aneurysm formation in animal models of abdominal aortic aneurysm. Although this effect is ascribed to matrix metalloproteinase-9 inhibition, such an effect is unclear in human studies. We reevaluated the effect of doxycycline on aortic wall protease content i...
journal_title:Circulation
pub_type: 杂志文章,随机对照试验
doi:10.1161/CIRCULATIONAHA.108.806505
更新日期:2009-04-28 00:00:00
abstract::This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiologic transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and th...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/hc4601.099487
更新日期:2001-11-27 00:00:00
abstract:BACKGROUND:Ventricular septal defect (VSD) complicating acute myocardial infarction has been studied primarily in small, prethrombolytic-era trials. Our goal was to determine clinical predictors and angiographic and clinical outcomes of this complication in the thrombolytic era. METHODS AND RESULTS:We compared enrollm...
journal_title:Circulation
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1161/01.cir.101.1.27
更新日期:2000-01-04 00:00:00
abstract::The effect of potassium ion (K+) depletion on postmyocardial infarction ventricular arrhythmias was investigated in 32 dogs: 12 control animals, 10 animals that ate a diet extremely low in K+ for 15 days, and 10 others that, in addition to dietary K+ deprivation, received 50 mg of hydrochlorothiazide four times. The e...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.77.3.696
更新日期:1988-03-01 00:00:00
abstract:BACKGROUND:Cyclosporin A is reported to impair endothelium-mediated vasorelaxation and induce endothelin release in some noncoronary vascular beds. We wished to determine whether acute cyclosporine administration induces endothelial dysfunction in coronary conductance or resistance arteries. METHODS AND RESULTS:We exa...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.90.6.3018
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:Lung transplantation and heart-lung transplantation represent surgical options for treatment of medically refractory idiopathic pulmonary arterial hypertension. The effect of the lung allocation score on wait-list and transplantation outcomes in patients with idiopathic pulmonary arterial hypertension is poo...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.112.001080
更新日期:2013-06-25 00:00:00
abstract:BACKGROUND:Gaps of sufficient cross-sectional dimensions within linear radiofrequency (RF) lesions may allow conduction through the lesion. The purpose of this study was to examine the effects of different gap geometries on conduction through discontinuous RF lesions. METHODS AND RESULTS:Radiofrequency lesions were cr...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.105.596593
更新日期:2006-04-11 00:00:00
abstract:BACKGROUND:The positions, sizes, and shapes of ventricular septal defects (VSDs) can be difficult to assess by 2-dimensional echocardiography (2DE). Volume-rendered 3-dimensional echocardiography (3DE) can provide unique views of VSDs from the left ventricular (LV) side, allowing complete assessment of their circumfere...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.98.13.1307
更新日期:1998-09-29 00:00:00
abstract:BACKGROUND:We conducted a 10-year follow-up of the 11 712 patients with acute myocardial infarction randomized in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto-1 study, the first large trial assessing thrombolytic therapy. METHODS AND RESULTS:Information on survival at 10 years was obtained for th...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.98.24.2659
更新日期:1998-12-15 00:00:00
abstract:BACKGROUND:Transplantation of ex vivo expanded circulating endothelial progenitor cells (EPCs) from peripheral blood mononuclear cells improves the neovascularization after critical ischemia. However, the origin of the endothelial progenitor lineage and its characteristics have not yet been clearly defined. Therefore, ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.CIR.0000096483.29777.50
更新日期:2003-11-18 00:00:00
abstract:BACKGROUND:Survivors of out-of-hospital cardiac arrest not associated with acute myocardial infarction are at high risk for recurrent cardiac arrest and sudden cardiac death. The impact of the implantable cardioverter-defibrillator on long-term prognosis in these patients is uncertain. METHODS AND RESULTS:Three hundre...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.88.3.1083
更新日期:1993-09-01 00:00:00
abstract:BACKGROUND:We studied the effect of an antioxidant, the intracoronary infusion of vitamin C, on basal and dobutamine-stimulated left ventricular (LV) contractility. METHODS AND RESULTS:Nineteen patients with normal ventricular function participated in this study. A micromanometer-tipped catheter was inserted into the ...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.103.6.826
更新日期:2001-02-13 00:00:00
abstract:BACKGROUND:Aortic valve-preserving procedures have resulted in excellent outcomes in selected patients, particularly those with normal aortic valve leaflets and dilated aortic roots. However, several congenital heart lesions are associated with abnormal aortic valve leaflets. The long-term results of aortic valve repai...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.102.suppl_3.iii-40
更新日期:2000-11-07 00:00:00
abstract:BACKGROUND:Aortic valve replacement remains the treatment of choice for aortic valve disease, even in the extreme elderly who may present with advanced symptoms. Defining risk factors for short-term survival was the object of this study. METHODS AND RESULTS:This was a retrospective analysis of 717 patients at least 70...
journal_title:Circulation
pub_type: 杂志文章
doi:
更新日期:1993-11-01 00:00:00