检索结果-内蒙古大学图书馆

Timing of and risk factors for myocardial ischemic events after percutaneous coronary intervention (IMPACT-II)

AMERICAN JOURNAL OF CARDIOLOGY 2000年第4期85卷 427-434页

作者： Thel, MC Califf, RM Tardiff, BE Gardner, LH Sigmon, KN Lincoff, AM Topol, EJ Kitt, MM Blankenship, JC Tcheng, JE Duke Clin Res Inst Durham NC 27715 USA Cleveland Clin Fdn Dept Cardiol Cleveland OH 44195 USA COR Therapeut Inc S San Francisco CA USA Weis Ctr Res Geisinger Clin Danville PA 17822 USA

We studied both the time course and risk factors for adverse clinical events after percutaneous coronary intervention (PCI). Such information is critical to clinical decision-making, but scant quantitative data exist to describe the time course of these adverse outcomes. Patients enrolled in the Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis-ii (IMPACT-II) trial were analyzed. Patients undergoing elective, urgent, or emergency PCI (n = 4,010) were randomized to receive either placebo or 1 of 2 eptifibatide regimens during intervention. We evaluated the time to the primary end point of the trial, the 30-day composite of death, myocardial infarction, repeat nonelective PCI, nonelective bypass surgery, or stenting for abrupt closure. Adverse events occurred in 407 patients (10.1%). Because the risk of events declined substantially between 6 and 9 hours (66% occurred within b hours), events were classified as occurring before or after 6 hours. Independent predictors of "early" events included dissection, pre- and postprocedural coronary blood flow, side-branch occlusion, procedural thrombolytic use, previous bypass, presentation with unstable angina, absence of diabetes, and hyperlipidemia. The predictors of "late" events included lower weight, increased baseline heart rate, coronary dissection, and procedural thrombolytic use. The risk of ischemic events were greatest immediately after PCI and rapidly declined, so that by 9 hours the hazard function plot was flat;66% of events occurred within 6 hours of PCI. Knowledge of the risk factors for early and late events help risk-stratify patients before and after intervention for myocardial ischemic events. (C) 2000 by Excerpta Medico, Inc.

关键词：心绞痛不稳定型/死亡率心绞痛不稳定型/治疗冠状动脉血栓形成/死亡率冠状动脉血栓形成/治疗心电描记术输注静脉内心肌梗死/病因学心肌梗死/死亡率肽类/投药和剂量肽类/治疗应用血小板聚集抑制剂/投药和剂量血小板聚集抑制剂/治疗应用前瞻性研究复发/预防和控制危险因素存活率血栓溶解疗法时间因素治疗结果美国/流行病学老年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Prognostic significance of elevated hemostatic markers in patients with acute myocardial infarction

引用

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期33卷 1543-1548页

作者： Li, YH Teng, JK Tsai, WC Tsai, LM Lin, LJ Guo, HR Chen, JH Natl Cheng Kung Univ Hosp Dept Internal Med Div Cardiol Tainan 70428 Taiwan

OBJECTIVES The purpose of this study was to determine whether the elevated levels of hemostatic markers in the early phase of myocardial infarction may serve as risk factors for subsequent cardiac mortality. BACKGROUND Increased plasma hemostatic markers were noted in acute myocardial infarction, indicating that the blood coagulation system is highly activated in those patients. However, there are few clinical data concerning the association between the elevated hemostatic markers and survival in patients with myocardial infarction. METHODS Blood samples were obtained from 63 patients (mean age 67 w+/- 11 years;49 male)with acute myocardial infarction within 12 h after the onset of symptoms and before the initiation of any antithrombotic treatment. We measured plasma concentrations of fibrinopeptide A (FPA), prothrombin fragment 1+2 (F1+2) and thrombin-antithrombin complex (TAT) using the enzyme-linked immunosorbent assay method, and examined the associations between the level of these markers and survival with Cox proportional hazards models. RESULTS The follow-up time was 27 +/- 17 months, and 19 patients died of cardiac causes during inr follow-up. Univariate survival analysis identified Killip class IV (hazard ratio 4.86;95% confidence interval [CI] 1.55-15.19), left ventricular ejection fraction (hazard ratio 0.94;95% CI 0.90-0.99), FPA (hazard ratio 1.54;95% CI 1.13-2.10), F1+2 (hazard ratio 2.03;95% CI 1.17-3.53) and TAT (hazard ratio 1.88;95% CI 1.27-2.79) as significant factors associated with cardiac mortality In multivariate analyses, only FPA level (hazard ratio 1.84;95% CI 1.03-3.30) and left ventricular ejection fraction (hazard ratio 0.93;95% CI 0.88-0.98) were independent predictors of cardiac mortality. CONCLUSIONS Elevated FPA in the early phase of myocardial infarction identifies patients with increased risk for subsequent cardiac death. This association appears to be independent of residual left ventricular function after infarction. (C) 1999 by

关键词：抗凝血酶Ⅲ/代谢冠状动脉血栓形成/血液冠状动脉血栓形成/诊断冠状动脉血栓形成/死亡率纤维蛋白肽A/代谢随访研究止血/生理学心肌梗死/血液心肌梗死/诊断心肌梗死/死亡率肽碎片/代谢肽水解酶类/代谢预后凝血酶原/代谢危险性评估存活率成年人老年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Enoxaparin in acute coronary syndromes: Evidence for superiority over placebo or untreated control

引用

AMERICAN HEART JOURNAL 2002年第5期143卷 748-752页

作者： Massel, D Cruickshank, MK Univ Western Ontario London Hlth Sci Ctr Dept Med London ON N6A 4G5 Canada

Background Heparins, both standard unfractionated heparin (SUFH) and low-molecular weight heparin, play a prominent role in the treatment of acute coronary syndromes. Enoxaparin has been shown in 2 trials to be superior to heparin but has not been compared with placebo or untreated control. Methods A putative enoxaparin versus placebo/control odds ratio (OR) was computed with a recently described statistical technique with the logarithm of the ORs of the pooled results of both the enoxaparin-SUFH trials and SUFH-placebo or controlled trials. Results The combined heparin versus control results show a 33% reduction in the risk of death or acute myocardial infarction (AMI), with an OR of 0.67 (95% confidence interval [CI], 0.45 to 0.99). At up to 12 weeks (data from only 4 trials), the combined results show a 21% reduction (OR, 0.79;95% CI, 0.54 to 1. 15;P = .23). The 2 enoxaparin trials show a nonsignificant 20% reduction in the risk of death or AMI during treatment (OR, 0.80;95% CI, 0.68 to 1.16;P = .24) and a significant reduction at 43 days (OR, 0.82;95% CI, 0.69 to 0.97;P = .022). With these pooled data, the putative OR for enoxaparin versus placebo/untreated control during treatment is 0.53 (95% CI, 0.31 to 0.92;P = .023). The data are consistent with a 47% reduction in the risk of death or AMI. The difference persists on longer term follow-up period (OR, 0.65;95% CI, 0.43 to 0.98;P = .04). The risk of bleeding is nonsignificantly increased (OR, 2.32;95% CI, 0.8 to 7.85;P = .51). Conclusion On the basis of this methodology, enoxaparin would appear to be more effective than placebo when added to aspirin in acute coronary syndromes. Moreover, the effect of enoxaparin is similar to the results of a metaanalysis of trials of other low-molecular weight heparins versus placebo/control.

关键词：抗凝药/治疗应用阿司匹林/治疗应用置信区间冠状动脉血栓形成/死亡率冠状动脉血栓形成/预防和控制药物疗法联合依诺肝素/治疗应用纤维蛋白溶解药/治疗应用肝素低分子量/治疗应用心肌梗死/死亡率心肌梗死/预防和控制比值比综合征人类

来源：评论

学校读者我要写书评

暂无评论

Effectiveness of aspirin and clopidogrel combination therapy in coronary stenting

引用

AMERICAN JOURNAL OF CARDIOLOGY 1999年第6期84卷 726-+页

作者： Jauhar, R Bergman, G Savino, S Deutsch, E Shaknovich, A Parikh, M Sanborn, TA New York Presbyterian Hosp Dept Med Div Cardiol New York NY 10021 USA

Intracoronary stents have significantly advanced the treatment of coronary artery disease.(1-3) Early data with self-expanding stents, however, showed early stent thrombosis rates of 24%.(4) Aggressive antiplatelet and anticoagulation regimens of dextran, aspirin, dipyridamole, and warfarin led to a reduction in early stent thrombosis to 3% to 4%, but greatly increased the rate of bleeding and vascular complications to as high as 13%.(2) Combination antiplatelet therapy after intracoronary stenting with aspirin and ticlopidine became standard practice after several nonrandomized trials showed reduced complication rates in patients with stents.(5-7) More recently, randomized trials demonstrated that aspirin and ticlopidine had a significantly lower primary cardiac end point rate (0.5%) than aspirin alone (3.6%) or than aspirin and warfarin (2.7%) in patients with coronary stents.(8-10) Ticlopidine, however, carries the risk of severe neutropenia (0.8% of patients), and compliance may be limited by twice-a-day dosing and,gastrointestinal intolerance. Recently, a new thienopyridine in the same class as ticlopidine, clopidogrel (Plavix, Bristol-Myers-Squibb, Princeton, New Jersey), has been introduced which has the purported advantage of a reduced incidence of severe neutropenia (0.04%), once-a-day dosing, a better side-effect profile, and a more rapid onset of action.(11) This study evaluates the safety, in-hospital, and 30-day clinical outcome in patients treated with aspirin and a 2-week course of clopidogrel after coronary stenting.

关键词：血管成形术经腔经皮冠状动脉阿司匹林/投药和剂量综合疗法冠心病/死亡率冠心病/治疗冠状动脉血栓形成/死亡率冠状动脉血栓形成/治疗剂量效应关系药物用药计划表药物疗法联合医院死亡率心肌梗死/死亡率心肌梗死/治疗血小板聚集抑制剂/投药和剂量复发支架噻氯匹定/投药和剂量噻氯匹定/类似物和衍生物治疗结果老年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案：

请选择收藏分类：

通借通还

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：