Abstract:
BACKGROUND:Adverse cardiovascular events associated with thrombotic occlusion occur in 4% to 12.8% of patients after coronary angioplasty. Recently, potent antiplatelet agents have been used to reduce those thrombotic complications. Tirofiban is a highly selective, short-acting inhibitor of fibrinogen binding to platelet glycoprotein (GP) IIb/IIIa that inhibits ex vivo platelet aggregation in response to a variety of agonists. METHODS AND RESULTS:The RESTORE trial (Randomized Efficacy Study of Tirofiban for Outcomes and REstenosis) was a randomized, double-blind, placebo-controlled trial of tirofiban in patients undergoing coronary interventions (balloon angioplasty or directional atherectomy) within 72 hours of presentation with an acute coronary syndrome (unstable angina pcctoris or acute myocardial infarction). The end points of the study were death from any cause, myocardial infarction, coronary bypass surgery due to angioplasty failure or recurrent ischemia, repeat target-vessel angioplasty for recurrent ischemia, and insertion of a stent due to actual or threatened abrupt closure of the dilated artery, and the primary end point was a composite representing the occurrence of any of these events. The prespecified primary hypothesis of the study was that tirofiban, administered as a bolus of 10 microg/kg over a 3-minute period and followed by a 36-hour infusion of 0.15 microg x kg(-1) x min(-1), would result in a reduction in the 30-day composite end point compared with placebo. Patients (n=2139) who were already receiving treatment with aspirin and heparin were randomized to receive tirofiban or placebo. The primary composite end point at 30 days was reduced from 12.2% in the placebo group to 10.3% in the tirofiban group, a 16% relative reduction (P=.160). However, 2 days after angioplasty, the tirofiban group had a 38% relative reduction in the composite end point (P< or =.005), and at 7 days there was a 27% relative reduction (P=.022), largely because of a reduction in nonfatal myocardial infarction and the need for repeat angioplasty. When repeat angioplasty or coronary artery bypass surgery procedures were included in the composite only if performed on an urgent or emergency basis, the composite 30-day event rates were 10.5% for the placebo group and 8.0% for the tirofiban group, a relative reduction of 24% (P=.052). Major bleeding, including transfusion, was not significantly different between the two groups (3.7% in the placebo group and 5.3% in the tirofiban group; P=.096). When the Thrombolysis In Myocardial Infarction (TIMI) criteria for major bleeding were used, the incidence was 2.1% in the placebo group compared with 2.4% in the tirofiban group (P=.662). Thrombocytopenia was similar in the placebo and tirofiban groups (0.9% for the placebo group versus 1.1% for the tirofiban group; P=.709). CONCLUSIONS:In patients undergoing coronary angioplasty for acute coronary syndromes, tirofiban protects against early adverse cardiac events related to thrombotic closure. At 30 days, however, the reduction in adverse cardiac events was no longer statistically significant. The bleeding observed with tirofiban was not statistically different from that observed with placebo.
journal_name
Circulationjournal_title
Circulationauthors
doi
10.1161/01.cir.96.5.1445subject
Has Abstractpub_date
1997-09-02 00:00:00pages
1445-53issue
5eissn
0009-7322issn
1524-4539journal_volume
96pub_type
临床试验,杂志文章,随机对照试验相关文献
CIRCULATION文献大全abstract:BACKGROUND:Subclinical inflammation is associated with an increased risk of heart failure and with adverse prognosis in patients with established heart failure. Yet, treatments specifically directed at reducing inflammation in patients with heart failure have not yet shown improved clinical outcomes. We tested the hypo...
journal_title:Circulation
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1161/CIRCULATIONAHA.118.038010
更新日期:2019-03-05 00:00:00
abstract:BACKGROUND:Myocardial necrosis can occur during percutaneous coronary intervention (PCI) despite optimal adjunctive pharmacology and careful technique. We investigated the mechanisms of procedural infarction using angiographic analysis, intravascular ultrasound, and delayed-enhancement magnetic resonance imaging. METH...
journal_title:Circulation
pub_type: 临床试验,杂志文章
doi:10.1161/CIRCULATIONAHA.105.593210
更新日期:2006-08-15 00:00:00
abstract:BACKGROUND:Perioperative management of patients with complete mixing of pulmonary and systemic blood centers on approximately equating pulmonary (Qp) and systemic (Qs) blood flow (Qp/Qs approximately 1). This empirically derived target is opposed by theoretical studies advocating a target Qp/Qs well below 1. We studied...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.100.21.2198
更新日期:1999-11-23 00:00:00
abstract:BACKGROUND:Current information on the epidemiology and outcomes of hypertrophic cardiomyopathy (HCM) in children is limited by disease diversity and small case series. METHODS AND RESULTS:The Pediatric Cardiomyopathy Registry has collected prospective and retrospective data on children diagnosed with HCM since 1990. W...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.106.621185
更新日期:2007-02-13 00:00:00
abstract:BACKGROUND:With recognition of disease-causing genes in arrhythmogenic right ventricular cardiomyopathy, mutation analysis is being applied. METHODS AND RESULTS:The role of genotyping in familial assessment for arrhythmogenic right ventricular cardiomyopathy was investigated, including the prevalence of mutations in k...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.110.976936
更新日期:2011-06-14 00:00:00
abstract::This study was undertaken to assess the ability of proton magnetic resonance imaging (MRI) to detect myocardial ischemia shortly after coronary artery occlusion. Fifteen dogs were studied before and serially for up to 6 hr after anterior descending or circumflex coronary artery ligation in vivo by gated MRI with a 0.1...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.71.3.587
更新日期:1985-03-01 00:00:00
abstract:BACKGROUND:In recent decades, the rates of incident acute myocardial infarction (AMI) have declined in the United States, yet disparities by sex remain. In an integrated healthcare delivery system, we examined temporal trends in incident AMI among women and men. METHODS:We identified hospitalized AMI among members ≥35...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.119.044738
更新日期:2020-02-18 00:00:00
abstract:BACKGROUND:Cardiomyocyte grafting augments myocyte numbers in the heart. We investigated (1) how developmental stage influences graft survival; (2) whether acutely necrotic or healing cardiac lesions support grafts; and (3) the differentiation and integration of cardiomyocyte grafts in injured hearts. METHODS AND RESU...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.100.2.193
更新日期:1999-07-13 00:00:00
abstract:BACKGROUND:Mildly oxidized LDL (moxLDL) is thought to play a role in atherogenesis. MoxLDL induces derivatization of cell proteins and triggers a variety of intracellular signaling. We aimed to investigate whether moxLDL-induced protein derivatization may influence the activity of platelet-derived growth factor recepto...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/hc4001.097179
更新日期:2001-10-09 00:00:00
abstract:BACKGROUND:Growth factors such as platelet-derived growth factor (PDGF) have been postulated to be important mediators of neointimal formation in balloon-injured artery. Binding of growth factors to their receptors activates intrinsic receptor tyrosine kinase, resulting in tyrosine phosphorylation of receptors themselv...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.96.6.1906
更新日期:1997-09-16 00:00:00
abstract::Cardiac arrest systems of care are successfully coordinating community, emergency medical services, and hospital efforts to improve the process of care for patients who have had a cardiac arrest. As a result, the number of people surviving sudden cardiac arrest is increasing. However, physical, cognitive, and emotiona...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIR.0000000000000747
更新日期:2020-03-24 00:00:00
abstract::Twenty-six major cardiovascular centers participated in a cooperative study of all cases of infective endocarditis occurring during a single calendar year to obtain an overview of infective endocarditis. The study was designed to learn which patients appear to be at highest risk to develop this infection after palliat...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.59.2.327
更新日期:1979-02-01 00:00:00
abstract:BACKGROUND:Race and sex disparities in in-hospital treatment and outcomes of patients with acute myocardial infarction (MI) have been described, but little is known about race and sex differences in post-MI angina and long-term risk of unplanned rehospitalization. We examined race and sex differences in post-MI angina ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.116.024406
更新日期:2017-02-07 00:00:00
abstract:BACKGROUND:The aims of this study were to identify hibernating myocardium (hypocontractile, hypoperfused viable myocardium that regains contractility after revascularization) in the clinical setting and to predict functional outcome in patients with coronary artery disease after coronary revascularization. METHODS AND...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.94.3.308
更新日期:1996-08-01 00:00:00
abstract:BACKGROUND:Treatment of aortocaval fistulae (ACFs) by open surgery is known to be a high-risk procedure. In this experimental study, we developed a percutaneous model of ACF to test a new nonsurgical method of treatment of ACF using endovascular stent grafts. METHODS AND RESULTS:An ACF was created percutaneously in ei...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.94.1.108
更新日期:1996-07-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to investigate the prevalence of skeletal muscle atrophy and its relation to exercise intolerance and abnormal muscle metabolism in patients with heart failure (HF). METHODS AND RESULTS:Peak VO2, percent ideal body weight (% IBW), 24-hour urine creatinine (Cr), and anthropometr...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.85.4.1364
更新日期:1992-04-01 00:00:00
abstract:BACKGROUND:The genetic basis of left ventricular (LV) image-derived phenotypes, which play a vital role in the diagnosis, management, and risk stratification of cardiovascular diseases, is unclear at present. METHODS:The LV parameters were measured from the cardiovascular magnetic resonance studies of the UK Biobank. ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.119.041161
更新日期:2019-10-15 00:00:00
abstract:BACKGROUND:Treatment with an antibody that binds beta3 integrins (abciximab; c7E3 Fab) at the time of coronary angioplasty decreases the need for repeat revascularization. Two potential mechanisms have been proposed to explain this effect: (1) inhibition of platelet aggregation or (2) interruption of ligand binding to ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.97.9.907
更新日期:1998-03-10 00:00:00
abstract:BACKGROUND:In patients with acute minor ischemic stroke or high-risk transient ischemic attack enrolled in the POINT trial (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke [POINT] Trial), the combination of clopidogrel and aspirin for 90 days reduced major ischemic events but increased major hemorrhag...
journal_title:Circulation
pub_type: 杂志文章,随机对照试验
doi:10.1161/CIRCULATIONAHA.119.040713
更新日期:2019-08-20 00:00:00
abstract:BACKGROUND:Resting cardiac function does not necessarily affect exercise capacity. However, to determine whether it affects early dynamics of oxygen uptake (VO2) during exercise, we measured VO2 during a constant work rate and during incremental exercise testing in patients with a history of myocardial infarction. VO2 ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.90.5.2324
更新日期:1994-11-01 00:00:00
abstract::The key initiating process in atherogenesis is the subendothelial retention of apolipoprotein B-containing lipoproteins. Local biological responses to these retained lipoproteins, including a chronic and maladaptive macrophage- and T-cell-dominated inflammatory response, promote subsequent lesion development. The most...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/CIRCULATIONAHA.106.676890
更新日期:2007-10-16 00:00:00
abstract::The mechanism of atrial flutter is controversial. A 76-year-old woman with rheumatic heart disease was referred to our clinic with an unusual rhythm disturbance which initially appeared to be classic atrial flutter at a rate of 300 beats/min. Later tracings, however, demonstrated a rate exactly one-half that of the ea...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.60.3.711
更新日期:1979-09-01 00:00:00
abstract:BACKGROUND:Previous experimental studies have shown that the effect of serotonin on a coronary stenosis depends on whether that stenosis is compliant or fixed. However, the relation between coronary stenosis morphology and the response to serotonin in patients with angina is not known. METHODS AND RESULTS:Using comput...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.88.4.1518
更新日期:1993-10-01 00:00:00
abstract:BACKGROUND:Identification of genes that are specifically activated in restenosis lesions after percutaneous transluminal angioplasty represents a necessary step toward molecular manipulation designed to inhibit cellular proliferation responsible for such lesions. Whereas quiescent smooth muscle cells (contractile pheno...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.85.2.543
更新日期:1992-02-01 00:00:00
abstract:BACKGROUND:The timing of onset of angina before myocardial infarction in relation to outcome is unknown. METHODS AND RESULTS:We prospectively determined the importance of the time of onset of preinfarction angina in relation to 30-day outcomes in the TIMI-9B study from standardized forms. Of the 3002 patients entered ...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/01.cir.97.11.1042
更新日期:1998-03-24 00:00:00
abstract:BACKGROUND:The incidence and cause of sudden cardiac death (SCD) in athletes is debated with hypertrophic cardiomyopathy often reported as the most common cause. METHODS AND RESULTS:A database of all National Collegiate Athletic Association deaths (2003-2013) was developed. Additional information and autopsy reports w...
journal_title:Circulation
pub_type: 杂志文章,评审
doi:10.1161/CIRCULATIONAHA.115.015431
更新日期:2015-07-07 00:00:00
abstract:BACKGROUND:Recombinant staphylokinase (STAR) was shown recently to offer promise for coronary arterial thrombolysis in patients with evolving myocardial infarction. The present multicenter randomized open trial was designed to assess the thrombolytic efficacy, safety, and fibrin specificity of STAR relative to accelera...
journal_title:Circulation
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1161/01.cir.92.8.2044
更新日期:1995-10-15 00:00:00
abstract:BACKGROUND:Risk stratification algorithms for coronary artery bypass grafting (CABG) do not include a weighting for preoperative mild renal impairment defined as a serum creatinine 130 to 199 micromol/L (1.47 to 2.25 mg/dL), which may impact mortality and morbidity after CABG. METHODS AND RESULTS:We reviewed prospecti...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.104.522623
更新日期:2005-08-30 00:00:00
abstract:BACKGROUND:The biological response to antiplatelet drugs has repeatedly been shown to predict the recurrence of major adverse cardiovascular events (MACEs). However, most studies involved coronary artery disease patients with recent vessel injury shortly after the initiation of antiplatelet therapy. Data on stable card...
journal_title:Circulation
pub_type: 杂志文章
doi:10.1161/CIRCULATIONAHA.111.085464
更新日期:2012-06-26 00:00:00
abstract::Defibrillation/cardioversion thresholds were measured in 33 patients undergoing defibrillator implants. Each patient had a 12 cm2 patch placed near the left ventricular apex via a thoracotomy and a 10 cm2 spring lead placed pervenously at the right atrial-superior vena caval junction. Ventricular tachycardia of stable...
journal_title:Circulation
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1161/01.cir.69.4.766
更新日期:1984-04-01 00:00:00