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1.
Chiara Lazzeri Serafina Valente Marco Chiostri Claudio Picariello Gian Franco Gensini 《Internal and emergency medicine》2011,6(1):41-46
Elderly patients are under-represented in trials assessing strategies of early coronary revascularization in acute myocardial
infarction, though they are the fastest growing segment of our population. The aims of the present investigation, performed
in 357 elderly (≥75 years) patients with ST elevation myocardial infarction (STEMI) submitted to primary percutaneous coronary
intervention (PCI) consecutively admitted to our Intensive Cardiac Care Unit (ICCU) from 1 January 2006 to 31 December 2009,
were as follows: (a) to identify predictors for in-ICCU mortality among clinical, angiographic and metabolic factors and (b)
to evaluate whether there are gender-related differences in management, outcome and in the metabolic and inflammatory responses
to acute myocardial ischemia. At multivariable backward stepwise logistic regression analysis, the following variables were
independent predictors for in-ICCU mortality in the overall population: age (OR 1.15; 95% CI 1.05–1.27; p < 0.003), admission glycemia (OR 2.24; 95% CI 1.41–3.56; p < 0.001), left ventricular ejection fraction (LVEF) (OR 0.92; 95% CI 0.88–0.97; p < 0.001), primary PCI failure (OR 4.70; 95% CI 1.70–12.98; p < 0.003). In elderly STEMI patients submitted to primary PCI, early mortality can be related to age, hemodynamic derangement
(as indicated by LVEF), the rate of procedural success, and increased glucose values. No gender-related differences in management
were detectable in our series. Our data strongly suggest that, in elderly patients in the acute phase of STEMI, since hyperglycemia
is a modifying factor, glucose values deserve a more intensive treatment. Further studies, performed specifically in elderly
STEMI patients, should be addressed to identify the glucose cut-off values able to influence the outcome. 相似文献
2.
Kievit PC Brouwer MA Veen G Aengevaeren WR Verheugt FW 《Journal of thrombosis and thrombolysis》2009,27(4):385-393
Background In smokers treated with fibrinolysis for ST-elevation myocardial infarction (STEMI) a paradoxical beneficial short-term outcome
has been reported. This was attributed to favorable clinical and angiographic baseline variables and a better response to
fibrinolysis. During follow-up infarct artery reocclusion is an important prognosticator. We studied the effects of smoking
on reocclusion and long-term cardiac outcome after successful fibrinolysis. Methods In the Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis trials (APRICOT-1 and -2) 499 STEMI patients
with an open infarct artery <48 h after fibrinolysis received randomized antithrombotic treatment until 3-month follow-up
angiography. Five-year clinical follow-up was complete. Results Current smokers (317 patients, 64%) had favorable clinical (age 54 vs. 60 years, P < 0.01) and angiographic (single vessel disease 61% vs. 49%, P = 0.02) baseline characteristics. Reocclusion rates were 21% (67/317) in smokers versus 32% (59/182) in non-smokers (P < 0.01). Five-year infarct-free cardiac survival did not differ: 82% vs. 85%. Reocclusion (HR 2.41, 95%CI 1.05–5.56, P = 0.04) independently predicted cardiac mortality. Smoking was independently associated with a reduced risk of reocclusion
(OR 0.58, 95%CI 0.37–0.91, P = 0.02), but not with improved 5-year cardiac outcome (HR 1.34, 95%CI 0.79–2.25, P = ns). Conclusions After successful fibrinolysis, smoking is independently associated with a more than 40% reduced risk of reocclusion, which
is an independent predictor of adverse outcome. However, even with more favorable baseline characteristics smokers did not
have improved 5-year cardiac outcome in this low-risk population. 相似文献
3.
Eliano Pio Navarese Stefano De Servi Antonino Buffon Harry Suryapranata Giuseppe De Luca 《Journal of thrombosis and thrombolysis》2011,31(2):217-225
Primary Percutaneous Intervention (PCI) is the treatment of choice for acute ST-elevation myocardial infarction (STEMI). Nearly
half of STEMI patients have multivessel (MV) disease that has been associated with worse survival. However, current guidelines
recommend to treat only the culprit artery (COR) during the acute procedure. Thus, the aim of the current study was to perform
a meta-analysis of trials comparing MV PCI vs. COR for STEMI patients with MV disease. Medline/CENTRAL and Web were searched
for comparative studies (both randomized and non randomized trials) about MV PCI vs. COR for STEMI patients reporting mortality,
re-PCI and re-MI data. Primary endpoint was 30-day mortality. The meta-analysis included 10 studies (2 randomized and 8 registries;
N = 31224). As compared with COR, MV PCI significantly reduced long term rate of re-PCI (OR [95% CI] = 0.47 [0.28–0.78], P = 0.003) without increasing 30-day mortality (OR [95% CI] = 1.30 [0.79–2.12], P = 0.31) and long term re-MI (OR [95% CI] = 0.94 [0.43–2.06], P = 0.88). This meta-analysis showed safety and efficacy of MV PCI approach as compared with COR, with a significant reduction
in rate of revascularizations, but no advantages in death and re-MI. 相似文献
4.
We sought to assess prevalence, and utility of discriminant function (DF) and MELD score in predicting septic events (SE), type 1 hepatorenal syndrome (HRS), and short-term mortality in severe alcoholic hepatitis (AH). Charts of patients with AH (group 1) and cirrhosis without AH (group 2) were retrospectively reviewed. Severe AH, discriminant function (DF) ≥ 32 was treated with pentoxifylline. One hundred ninety-five patients were enrolled in the study and divided into 2 groups: group 1, n=99, and group 2, n=96. Of those with AH, 82% had a DF ≥ 32 at presentation. Group 1 patients had a higher prevalence of SE (38% versus 25%, P=.04), type 1 HRS (30% versus 9%, P=.0003), and short-term mortality (28% versus 7%, P=.0001). In patients with AH, a MELD score ≥20 (but not a DF ≥ 32) at presentation was an independent predictor of a SE (odds ratio [OR] 2.8 [1.0–7.9], P=.04), HRS (OR 4.0, 95% confidence interval [CI] 1.0–16.6, P=0.05), and short-term mortality (OR 6.4, 95% CI 1.1–37.6, P=.03). Kaplan-Meier survival curves confirmed that that a MELD ≥ 20 but not a DF ≥ 32 was associated with a poorer survival (P = .005 and .5, respectively). In conclusion, patients with severe AH have higher prevalence of SE, HRS, and short-term mortality compared to those with cirrhosis without AH. A MELD score ≥20 at presentation is an independent predictor of these adverse events in patients with AH who have been treated with pentoxifylline. 相似文献
5.
Mehta RH Stebbins A Lopes RD Rao SV Bates ER Pieper KS Armstrong PW Van de Werf F White HD Califf RM Alexander JH Granger CB 《The American journal of medicine》2011,(1):48-57
Background
Studies have shown higher bleeding and mortality rates among African Americans who receive fibrinolytic therapy for ST-segment elevation myocardial infarction (STEMI) compared with whites; however, the relationship of bleeding risk to mortality has not been evaluated.Methods
We studied data from 32,260 STEMI patients receiving fibrinolysis enrolled in the US in 5 clinical trials. Bleeding was defined according to criteria from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries study. Main outcome measure was adjusted 1-year mortality.Results
Despite younger age (median: 57 years vs 61 years) and fewer comorbidities, moderate or severe bleeding occurred more frequently among African-Americans than whites (16.3% vs 14.1%; P = .0147, adjusted OR 1.36; 95% confidence interval [CI], 1.14-1.62; P = .0006) as did 1-year mortality (11.5% vs 9.4%). African-American race and moderate or severe bleeding were independently related to 1-year mortality (χ2 9.02, P = .0003 and 148.58, P < .0001, respectively). Mortality was highest among African Americans with bleeding (hazard ratio [HR] 2.83; 95% CI, 2.08-3.86) followed by whites with bleeding (HR 1.99; 95% CI, 1.78-2.22) and African Americans without bleeding (HR 1.33; 95% CI, 1.02-1.73) (referent whites without bleeding).Conclusions
In STEMI patients receiving fibrinolysis, moderate or severe bleeding and mortality were significantly higher in African Americans compared with whites. Bleeding was associated with similarly increased mortality risk in both groups. 相似文献6.
Giuseppe De Luca Marco Valgimigli Christian Spaulding Maurizio Menichelli Hans Peter Brunner-La Rocca Bas L. van der Hoeven Emilio Di Lorenzo Luis-S. Diaz de la Llera Vincenzo Pasceri Undine Pittl Gianfranco Percoco Roberto Violini Gregg W. Stone 《Journal of thrombosis and thrombolysis》2009,28(2):200-210
Background Recent concerns have emerged on the potential higher risk of stent thrombosis after DES implantation, that might be even
more pronounced among STEMI patients. The aim of the current study was to perform a meta-analysis to evaluate the benefits
and safety of Sirolimus-Eluting Stent (SES) as compared to BMS in patients undergoing primary angioplasty for STEMI. Methods The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL). We examined all completed randomized
trials of DES for STEMI. The following keywords were used for study selection: randomized trial, myocardial infarction, reperfusion,
primary angioplasty, stenting, DES, sirolimus-eluting stent (SES), Cypher. Information on study design, type of stent, inclusion
and exclusion criteria, primary endpoint, number of patients, angiographic and clinical outcome, were extracted by two investigators.
Disagreements were resolved by consensus. Results A total of 9 trials were included in the meta-analysis, involving 2,769 patients (1389 or 50.2% randomized to DES and 1,380
or 49.8% randomized to BMS). At 12 months follow-up, SES was associated with a significant reduction in TVR (4.9% vs. 13.6%,
p < 0.0001), with a trend in benefits in mortality (2.9% vs. 4.2%, p = 0.08) and reinfarction (3.0% vs. 4.3%, p = 0.06), without any significant difference in stent thrombosis (1.9% vs. 2.5%, p = 0.36). Safety and efficacy of DES were confirmed at 2–3 years follow-up (data available from 4 trials including 569 patients).
Conclusions This meta-analysis shows that among selected STEMI patients undergoing primary angioplasty, SES as compared to BMS is safe
and associated with a significant reduction in TVR at 1 and 2–3 years follow-up. 相似文献
7.
Robert C. Welsh Jay S. Shavadia Yinggan Zheng Benjamin D. Tyrrell Raymond Leung Kevin R. Bainey 《Clinical cardiology》2021,44(11):1543
ObjectivesTo describe and evaluate outcomes in STEMI patients sustained on clopidogrel compared to those switched to ticagrelor following fibrinolysis.BackgroundWorld‐wide, many STEMI patients cannot achieve timely PCI and therefore require fibrinolysis. Although comparable 30‐day and 1‐year safety was shown with clopidogrel or ticagrelor in the TREAT study, there is paucity of long‐term outcomes in pharmacoinvasive treated STEMI.MethodsWe conducted an observational cohort study evaluating consecutive pharmacoinvasive STEMI patients treated in a network, comparing those switched to ticagrelor to those sustained on clopidogrel. The primary efficacy composite was one‐year all‐cause death, recurrent myocardial infarction, and stroke with major bleeding and intracranial hemorrhage (ICH) as the safety outcomes. Multivariable Cox regression model was used to examine the association between P2Y12 inhibitor and outcomes with inverse probability weighting.ResultsOf 1426 pharmacoinvasive STEMI patients, 28% (n = 396) were converted to ticagrelor at a mean of 9.9 h after fibrinolysis with comparable GRACE Risk Scores (median; 158 vs 157, p0.352). The primary composite occurred in 3.5% of ticagrelor and 7.0% of clopidogrel treated patients (p0.014). Following adjustment, ticagrelor was associated with a 54% lower composite outcome (adjusted HR 0.46, 95% confidence interval 0.26–0.84). Major bleeding 6.3% vs 6.1% (NS) and ICH 0.0% vs 0.2% (NS) were similar.ConclusionsIn a prospective STEMI cohort, switching to ticagrelor compared with sustaining clopidogrel following fibrinolysis pharmacoinvasive reperfusion reduced recurrent ischemic events at 1‐year with no differences in major bleeding or ICH. Aligned with randomized data, these findings provide support to switch pharmaco‐invasively treated STEMI patients. 相似文献
8.
Verheugt FW Montalescot G Sabatine MS Soulat L Lambert Y Lapostolle F Adgey J Cannon CP 《Journal of thrombosis and thrombolysis》2007,23(3):173-179
Background Fibrinolytic therapy for acute ST-elevation myocardial infarction (STEMI) is frequently limited by delays in administration
and by incomplete reperfusion or reocclusion of the infarct-related artery. Intensified prehospital management of STEMI may
shorten time to treatment and improve outcomes.
Methods We carried out a prospective substudy in 11 ambulance systems in 216 of the 3,491 patients with STEMI who were enrolled in
the CLARITY-TIMI 28 trial. They were randomized in the ambulance to clopidogrel (n = 109) or placebo (n = 107) along with fibrinolysis, aspirin, and heparin. The primary endpoint was the composite of an occluded infarct-related
artery (TIMI flow grade 0 or 1), or death or recurrent myocardial infarction before angiography.
Results All patients received a fibrin-specific lytic and the baseline characteristics in both groups were comparable. The incidence
of the primary endpoint was 16.5% in the clopidogrel-treated and 27.1% in the placebo patients (adj OR 0.62, 95% CI 0.31–1.21,
p = 0.16), an effect that was consistent with the effects seen in the in-hospital patients in the main CLARITY-TIMI 28 trial.
Prehospital clopidogrel therapy reduced the incidence of an occluded infarct-related artery on the predischarge angiogram
(11.8% vs. 22.3%, adj OR 0.52, 95% CI 0.24–1.13, p = 0.10). The 30-day incidence of cardiovascular death, recurrent MI or recurrent myocardial ischemia requiring urgent revascularization
was 12.8% vs. 14.0% (adj OR 1.07, 95% CI 0.48–2.39, p = 0.87). Early TIMI major bleeding occurred in no clopidogrel patients compared with two placebo patients (1.9%).
Conclusions Addition of clopidogrel to medical reperfusion of STEMI with fibrinolysis, heparin, and aspirin before reaching the hospital
is feasible in medically equipped ambulances without an apparent increase in bleeding. Furthermore, prehospital clopidogrel
tended to show better early coronary patency compared to placebo, a result consistent with that observed in patients randomized
in-hospital in the CLARITY-TIMI 28 trial. 相似文献
9.
Ahmed S Michael Gibson C Cannon CP Murphy SA Sabatine MS 《Journal of thrombosis and thrombolysis》2011,31(4):493-500
Reduced glomerular filtration rate (GFR) is associated with adverse outcomes in patients with cardiovascular disease. We explored
the relationship between GFR and angiographic and clinical outcomes in ST-segment elevation myocardial infarction (STEMI)
patients receiving pharamacologic reperfusion, with or without clopidogrel. Data were available to estimate GFR in 3,252 STEMI
patients undergoing fibrinolysis, randomized to clopidogrel versus placebo in the CLARITY-TIMI 28 trial. Patients with a creatinine
> 2.5 mg/dl were excluded from the trial. We compared outcomes between patients with no, mild or moderate reductions in baseline
estimated GFR (ml/min/1.73 m2) of ≥90, 60–89, and <60, respectively. Compared to patients with no (n = 841) or mildly reduced GFR (n = 1897), those with moderately reduced GFR (n = 514) were older, more often female, and were more likely to have diabetes and hypertension (P ≤ 0.001 for all). The risk of the primary endpoint (an occluded infarct-related artery on angiography or death/myocardial
infarction by day 8), 30 day cardiovascular events (death, myocardial infarction, or urgent revascularization for recurrent
ischemia) and 30 day Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding increased as GFR declined (P for trend 0.003, <0.0001, and 0.0008 respectively). The adjusted risk of 30 day ischemic complications remained higher in
patients with moderately reduced versus normal GFR (OR 1.5, 95% CI 1.0−2.1, P = 0.04). Treatment with clopidogrel tended to yield greater benefit in patients with normal or mildly reduced GFR versus
in patients with moderately reduced GFR. In conclusion, STEMI patients with reduced GFR treated with medical reperfusion,
including dual antiplatelet therapy, have higher rates of adverse clinical outcome. Further research on optimal STEMI therapy
in this high-risk group is warranted. 相似文献
10.
Management Strategies and Outcomes of ST‐Segment Elevation Myocardial Infarction Patients Transferred After Receiving Fibrinolytic Therapy in the United States 下载免费PDF全文
Nish Patel MD Nileshkumar J. Patel MD Badal Thakkar MD Vikas Singh MD Shilpkumar Arora MD MPH Nilay Patel MD Chirag Savani MD Abhishek Deshmukh MD Udho Thadani MD Apurva O. Badheka MD FACP CCDS Carlos Alfonso MD Gregg C. Fonarow MD Mauricio G. Cohen MD 《Clinical cardiology》2016,39(1):9-18
Fibrinolytic therapy is still used in patients with ST‐segment elevation myocardial infarction (STEMI) when the primary percutaneous coronary intervention cannot be provided in a timely fashion. Management strategies and outcomes in transferred fibrinolytic‐treated STEMI patients have not been well assessed in real‐world settings. Using the Nationwide Inpatient Sample from 2008 to 2012, we identified 18 814 patients with STEMI who received fibrinolytic therapy and were transferred to a different facility within 24 hours. The primary outcome was in‐hospital mortality. Secondary outcomes included gastrointestinal bleeding, bleeding requiring transfusion, intracranial hemorrhage (ICH), length of stay, and cost. The patients were divided into 3 groups: those who received medical therapy alone (n = 853; 4.5%), those who underwent coronary artery angiography without revascularization (n = 2573; 13.7%), and those who underwent coronary artery angiography with revascularization (n = 15 388; 81.8%). Rates of in‐hospital mortality among the groups were 20% vs 6.6% vs 2.1%, respectively (P < 0.001); ICH was 8.5% vs 1.1% vs 0.6%, respectively (P < 0.001); and gastrointestinal bleeding was 1.1% vs 0.4% vs 0.4%, respectively (P = 0.011). Multivariate analysis identified increasing age, higher Charlson Comorbidity Index score, cardiogenic shock, cardiac arrest, and ICH as the independent predictors of not performing coronary artery angiography and/or revascularization in patients with STEMI initially treated with fibrinolytic therapy. The majority of STEMI patients transferred after receiving fibrinolytic therapy undergo coronary angiography. However, notable numbers of patients do not receive revascularization, especially patients with cardiogenic shock and following a cardiac arrest. 相似文献
11.
Andrés Orlandini Rafael Díaz Daniel Wojdyla Karen Pieper Frans Van de Werf Christopher B Granger Robert A Harrington Eric Boersma Robert M Califf Paul Armstrong Harvey White John Simes Ernesto Paolasso 《European heart journal》2006,27(5):527-533
AIMS: To evaluate whether there is an association between 30-day mortality in patients with ST-segment elevation myocardial infarction (STEMI) included in clinical trials and country gross national income (GNI). METHODS AND RESULTS: A retrospective analysis of the databases of five randomized trials including 50 310 patients with STEMI (COBALT 7169, GIK-2 2931, HERO-2 17,089, ASSENT-2 17,005, and ASSENT-3 6116 patients) from 53 countries was performed. Countries were divided into three groups according to their GNI based on the World Bank data: low (less than 2900 US dollars), medium (between 2900 US dollars and 9000 US dollars), and high GNI (more than 9000 US dollars per capita). Baseline characteristics, in-hospital management variables, and 30-day outcomes were evaluated. A previously defined logistic regression model was used to adjust for differences in baseline characteristics and to predict mortality. The observed mortality was higher than the predicted mortality in the low (12.1 vs. 11.8%) and in the medium income groups (9.4 vs. 7.9%), whereas it was lower in the high income group (4.9 vs. 5.6%). CONCLUSION: An inverse relationship between mortality and GNI was observed in STEMI clinical trials. Most of the variability in mortality can be explained by differences in baseline characteristics; however, after adjustment, lower income countries have higher mortality than the expected. 相似文献
12.
Alfredo Renilla Manuel Barreiro Vicente Barriales Francisco Torres Paloma Alvarez Jose L Lambert 《Geriatrics & Gerontology International》2013,13(1):146-151
Aim: Elderly patients often remain underrepresented in clinical trials. The aim of our study was to analyze the treatment, clinical outcome and risk factors for mortality in patients aged ≥85 years with ST‐segment elevation myocardial infarction (STEMI). Methods: From 2005–2011, 102 patients aged ≥85 years with STEMI admitted to a coronary care unit were retrospectively reviewed. Clinical data, treatment and outcome were recorded. Reperfusion strategy and its influence in hospital morbidity and mortality were evaluated. Morbidity was defined as the presence of heart failure (Killip–Kimball >1), arrhythmias, mechanical complications, stroke or major bleeding. Risk factors for mortality were assessed by multivariate analysis. Results: The mean age was 87.5 ± 2.5 years (range 85–96). Therapeutic strategy on admission was: primary‐angioplasty (PCI) for 33 patients (32.3%) fibrinolysis for 30 patients (29.4%) and conservative treatment for 35 patients (34.3%). In the four remaining patients, rescue angioplasty was required. A total of 29 patients (28.4%) died, and morbidity was seen in 63 patients (61.7%). The morbidity and mortality rates in the conservative treatment group (77.1% and 48.5%) were higher than that found in the reperfusion strategy group (primary‐PCI and fibrinolysis; 53.7% and 17.9%; P = 0.02 and P = 0.002, respectively). Regarding mortality, the univariate analysis showed that heart failure on admission (P = 0.0001) and previous coronary artery disease (P = 0.01) were prognostic variables. Only heart failure was an independent risk factor for mortality (odds ratio = 3.64, 95% CI 0.78–21.87, P < 0.0001). Conclusions: Mortality and morbidity in very elderly patients with STEMI are very high, especially in those not receiving reperfusion therapies. Heart failure on admission was an independent risk factor for hospital mortality. Geriatr Gerontol Int 2013; 13: 146–151 . 相似文献
13.
Henny H. Billett Barbara A. Scorziello Emily R. Giannattasio Hillel W. Cohen 《Journal of thrombosis and thrombolysis》2010,30(4):479-485
Paucity of data has led to a lack of consensus regarding indications for, and risk–benefit ratio of, low molecular weight
heparin ‘bridging’ for cardioembolic prevention in patients with atrial fibrillation (AF) until their INR levels are in therapeutic
range. Using a hospital database, we compared AF patients ≥65 years who were bridged (n = 265) with patients who were not bridged (n = 4532) after hospital discharge. Patients who failed to achieve a therapeutic INR within 30 days were excluded. CHADS2 scores (congestive heart failure, hypertension, age ≥75, diabetes, stroke), bleeding risk and co-morbidity scores were assessed.
Unadjusted and adjusted odds ratios for outcome events (death, stroke, hemorrhage and venous thromboembolism (VTE) within
30 days of discharge were compared. Bridged patients, as compared to those not bridged, were younger (74.7 ± 6.6 vs. 78.5 ± 7.7 years),
less likely to be white (36 vs. 51%), and less likely to have CHADS2 scores ≥2 (67 vs. 84%), all P < 0.001. There was no significant difference in bleeding risk (bridged vs. not bridged: 1.5 ± 7 vs. 1.7 ± 6). In logistic
models adjusting for age, white race, bleeding risk, CHADS2 and Comorbidity scores, bridging was significantly associated with lower mortality and a decreased odds ratio for VTE (both
P < 0.01) but not for stroke or hemorrhage (both P > 0.80). Although we found insufficient evidence of either lower stroke or greater bleeding risk with bridging, our data
suggest the possibility that LMWH bridging in patients with AF is associated with lower risks of VTE and death within 30 days
of discharge. 相似文献
14.
Pride YB Buros JL Lord E Southard MC Harrigan CJ Ciaglo LN Sabatine MS Cannon CP Gibson CM;TIMI Study Group 《Journal of thrombosis and thrombolysis》2008,26(2):106-112
Background Among patients with ST-segment elevation myocardial infarction (STEMI), evidence of restoration of both normal epicardial
arterial flow and myocardial perfusion early after the administration of fibrinolytic agents has been associated with improved
clinical outcomes. In STEMI patients treated with fibrinolytic therapy and scheduled for angiography later during hospital
admission, however, the association of later indices of flow and perfusion with clinical outcomes has not been assessed.
Methods Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction (CLARITY-TIMI) 28 enrolled 3,491 STEMI
patients treated with fibrinolytic therapy. Angiography was scheduled 48–192 h (median 84) after randomization. The Angiographic
Perfusion Score (APS) (the sum of the TIMI Flow Grade and Myocardial Perfusion Grade before and after percutaneous coronary
intervention (PCI), range of 0–12) was assessed in the 1,460 patients treated with PCI at late angiography, and its association
with morbidity and mortality at 30 days was examined.
Results Full perfusion, defined as an APS of 10–12, was associated with the lowest mortality (0.8%), while partial perfusion (APS
4–9) (2.3%) and failed perfusion (APS 0–3) (18.0%) were associated with a higher incidence of mortality at 30 days (P < 0.001 for full perfusion vs. partial perfusion, P < 0.0001 for overall trend). In addition, full perfusion was associated with a lower incidence of recurrent myocardial infarction
(MI), a composite of death and MI, recurrent myocardial ischemia, ventricular tachyarrhythmia, congestive heart failure and
shock (P < 0.05 for all trends).
Conclusion Among STEMI patients treated with late PCI following fibrinolytic therapy, higher APS is associated with reduced morbidity
and mortality. 相似文献
15.
Shoaib Amlani Thanu Nadarajah Rizwan Afzal Renu Pal-Sayal John W. Eikelboom Madhu K. Natarajan 《Journal of thrombosis and thrombolysis》2010,30(4):434-440
Major bleeding has been associated with an increased risk of ischemic events and death in patients with acute coronary syndromes.
We examined the relationship between bleeding and outcome in 1,389 consecutive patients with ST-elevation myocardial infarction
(STEMI) presenting to a tertiary center between May 1, 2003 and July 10, 2007. We recorded bleeding, length of stay and death
during the first 30 days after hospitalization. Major bleeding occurred in 10.9% (152/1389, 95% confidence interval [CI] 9.3–12.6%).
In hospital mortality was significantly higher in patients with major bleeding compared to those without major bleeding (19.7
vs. 8.2%, odds ratio [OR] 2.8, 95% CI 1.8–4.3) and was evident in the subgroups of patients with a low TIMI STEMI risk score
(7.9 vs. 1.8%, OR 4.6, 95% CI 1.2–17.0) and medium risk score (11.7 vs. 6.3%, OR 2.0, 95% CI 0.6–6.2) but not those with a
high TIMI STEMI risk score (28.8 vs. 26.1%, OR 1.2, 95% CI 0.7–2.0) (P for interaction = 0.024). Our data indicate that serious bleeding is common in patients with STEMI treated with thrombolysis
or PCI and is a powerful predictor of death, particularly in patients with a low TIMI risk score. Therapies that maintain
efficacy while reducing bleeding and that reduce the risk of death in patients who develop bleeding are needed. 相似文献
16.
Iyori H Bessho F Ookawa H Konishi S Shirahata A Miyazaki S Fujisawa K Akatsuka J;Japanese Study Group on childhood ITP 《Annals of hematology》2000,79(12):691-695
We sent questionnaires to hospitals in Japan in order to study the incidence and conditions of intracranial hemorrhage (ICH)
in children with immune thrombocytopenic purpura (ITP). From 1980 to 1995, 11 cases of ICH were reported in eight patients
with ITP at 35 institutions. One patient had ICH four times, but only one patient died of the condition. From 1990 through
1995, ICH occurred in four (0.52%) of 772 patients with ITP. None of the patients died. The platelet count when ICH occurred
was 5.2±3.7×109/l (mean±SD) (n=11). Four of the eight patients (1980–1995) had received active treatment [e.g. intravenous immunoglobulin G (i.v. IgG)]
immediately before ICH occurred. In seven cases (1980–1995), possible causes of ICH, including menstruation (n=2) and viral infections (n=3), were identified. Systemic lupus erythematosus (SLE) later developed in three patients. Although the incidence of ICH
in children with ITP has not decreased compared with the rates in earlier studies, the mortality rate has decreased markedly.
Our results suggest that menstruation, infection, and risk factors for progression to SLE may help to predict ICH in children
with ITP. Large-scale prospective trials are needed to identify risk factors for ICH.
Received: 24 June 1999 / Accepted: 26 May 2000 相似文献
17.
Giebel S Krawczyk-Kulis M Adamczyk-Cioch M Jakubas B Palynyczko G Lewandowski K Dmoszynska A Skotnicki A Nowak K Holowiecki J;Polish Adult Leukemia Group 《Annals of hematology》2006,85(10):717-722
Outcome of adults with acute lymphoblastic leukemia (ALL) who fail to achieve complete remission (CR) or who relapse soon after initial response is poor. The goal of this phase II study by the Polish Adult Leukemia Group (PALG) was to evaluate safety and efficacy of a new salvage regimen (FLAM) consisting of sequential fludarabine, cytarabine, and mitoxantrone. Fifty patients were included with primary (n=13) or secondary (n=5) refractoriness, early (<12 months) first relapse (n=15), first relapse after hematopoietic cell transplantation (HCT) regardless CR duration (n=13), and second or subsequent relapse (n=4). Median age was 31(18–60) years, 28% of patients were bcr/abl-positive. CR rate equaled 50% and was significantly higher for patients in whom FLAM was administered as a second-line therapy compared to those more heavily pre-treated (66 vs 13%, p=0.02). Seventeen patients had leukemia regrowth after initial cytoreduction, whereas, eight patients died in aplasia. The incidence of early death was higher in patients aged ≥40 years compared to the younger subgroup (33 vs 8%, p=0.03). Septic infections were the most frequent severe complication. At 3 years, the probability of disease-free survival for patients who achieved CR equaled 16%. Seven patients underwent allogeneic HCT. FLAM regimen is feasible for relapsed and refractory adults with ALL and could be recommended in particular for younger patients as a second-line treatment. However, as the remission duration is short, allogeneic HCT (alloHCT) should be considered as soon as possible. 相似文献
18.
Khoobiar S Mejevoi N Kaid K Boiangiu C Setty S Tanwir A Khalid K Cohen M 《Journal of thrombosis and thrombolysis》2008,26(2):85-90
Background Enoxaparin use in PCI has been investigated, however its role in primary PCI is less known. Objective To evaluate the role of combination IV + SC enoxaparin in primary PCI
in STEMI. Methods 83 consecutive patients with STEMI who underwent primary PCI
between January 1, 2005 and January 15, 2008 were included. Anticoagulation was based on our institution’s STEMI
protocol; either IV + SC enoxaparin, or IV unfractionated heparin (UFH). Clinical endpoints included MACE, bleeding
and net adverse cardiac events (NACE). Results 45 patients received UFH and 37
received IV + SC enoxaparin. There was no difference in the rate of mortality, MACE, or NACE. There was a trend
toward more TIMI major and GUSTO moderate and severe bleeding in the UFH group. Conclusions
Application of IV + SC enoxaparin strategy for primary PCI in STEMI appears both safe and efficacious. A
prospective randomized trial will be necessary to evaluate the safety and efficacy more thoroughly. 相似文献
19.
Lee RJ Shih KN Lee SH Shyu KG Chiu CZ Lin SC Hung HF Liou JY Cheng JJ Kuan P 《Heart and vessels》2007,22(2):99-103
The purpose of this study was to investigate the predictor of long-term outcomes in patients after stent implantation for
unprotected left main coronary artery (LMCA) disease. Coronary stenting has recently been advocated as an alternative procedure
for LMCA disease. Information on the predictors of long-term outcomes in patients after stent implantation for unprotected
LMCA disease is not clear. Seventy six patients (51 men and 25 women, age 68 ± 10 years) with medically refractory angina
received coronary stenting for unprotected LMCA disease. During a follow-up period of 40 ± 26 months, 7 patients (9%) died
because of cardiovascular disease in 5 (7%) and noncardiovascular disease in 2 (3%). In the other 69 patients, 19 patients
(25%) needed repeated percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG). In a univariate
analysis, only female sex was related to the repeated PCI and/or CABG (P = 0.04). A history of cerebral vascular attack (CVA) (P = 0.005), anemia (P = 0.03) and lower left ventricular ejection fraction (LVEF) (P = 0.008) were related to the cardiovascular mortality. A history of myocardial infarction (P = 0.03), a history of CVA (P = 0.02), anemia (P = 0.02), and lower LVEF (P = 0.002) were related to the total mortality. In a multivariate analysis, female sex (P = 0.007; odds ratio 5.29, 95% confidence interval [CI] 1.57–17.80) and young age (P = 0.025; odds ratio 3.92, 95% CI 1.19–12.98) could predict the repeated PCI and/or CABG. Only a history of CVA could predict
the cardiovascular mortality (P = 0.027; odds ratio 34.18, 95% CI 1.49–783) and only lower LVEF could predict the total mortality (P = 0.027; odds ratio 13.26, 95% CI 1.34–131). Female sex and young age could predict the repeated PCI and/or CABG in patients
after stent implantation for unprotected LMCA disease. Furthermore, a history of CVA could predict the cardiovascular mortality
and lower LVEF could predict the total mortality. 相似文献
20.
Tomasz Rakowski Jacek Legutko Pawel Kleczynski Agata Brzozowska-Czarnek Artur Dziewierz Zbigniew Siudak Waldemar Mielecki Andrzej Urbanik Jacek S. Dubiel Dariusz Dudek 《Journal of thrombosis and thrombolysis》2010,30(4):441-445
Angiographic Perfusion Score (APS) proposed as a simple, angiographic score linking epicardial and myocardial perfusion parameters
before and after percutaneous coronary intervention (PCI) is a predictor of short-term outcome in patients with ST-segment
elevation myocardial infarction (STEMI) treated with PCI. Aim of the study was to analyze the correlation between APS and
both infarct size and left ventricular function in long-term follow-up. In a cohort of 68 patients with STEMI treated with
PCI APS was calculated for infarct-related artery based on angiographic parameters and was defined as the sum of the Thrombolysis
in Myocardial Infarction (TIMI) flow grade (0–3 points) and the TIMI myocardial perfusion grade (0–3 points) before and after
PCI (range of points from 0 to 12). Full perfusion was defined as APS ≥ 10. Cardiac magnetic resonance (CMR) parameters and
N-terminal pro-brain natriuretic peptide (NT pro-BNP) were assessed at 6 months. Results: Median APS was 7.5 points. APS ≥ 10
was present in 42% of patients. The significant correlation was found between APS and: CMR infarct size (r = − 0.48; P = 0.0001), CMR left ventricular (LV) ejection fraction (r = 0.5; P = 0.002), LV end-diastolic volume index (r = − 0.37; P = 0.004), LV end-systolic volume index (r = −0.41; P = 0.001), NT pro-BNP (r = − 0.5; P = 0.02). Patients with APS ≥ 10 had significantly lower infarct size, LV volumes, higher EF and lower NT pro-BNP. APS assessed
in patients with STEMI treated with PCI is a good predictor of infarct size and left ventricular function in 6-month follow-up. 相似文献