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Review
Mild therapeautic hypothermia (MTH) has been associated with cardiac dysrhythmias, coagulopathy and infection. After restoration of spontaneous circulation (ROSC), many cardiac arrest patients undergo percutaneous coronary intervention (PCI). The safety and feasibility of combined MTH and PCI remains unclear. This is the first study to evaluate whether PCI increases cardiac risk or compromises functional outcomes in comatose cardiac arrest patients who undergo MTH.Methods
Ninety patients within a 6-h window following cardiac arrest and ROSC were included. Twenty subjects (23%) who underwent PCI following MTH induction were compared to 70 control patients who underwent MTH without PCI. The primary endpoint was the rate of dysrhythmias; secondary endpoints were time-to-MTH induction, rates of adverse events (dysrhythmia, coagulopathy, hypotension and infection) and mortality.Results
Patients who underwent PCI plus MTH suffered no statistical increase in adverse events (P = .054). No significant difference was found in the rates of dysrhythmias (P = .27), infection (P = .90), coagulopathy (P = .90) or hypotension (P = .08). The PCI plus MTH group achieved similar neurological outcomes (modified Rankin Scale (mRS) ≤3 (P = .42) and survival rates (P = .40). PCI did not affect the speed of MTH induction; the target temperature was reached in both groups without a significant time difference (P = .29).Conclusion
Percutaneous coronary intervention seems to be feasible when combined with MTH, and is not associated with increased cardiac or neurological risk. 相似文献244.
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Januzzi JL Newby LK Murphy SA Pieper K Antman EM Morrow DA Sabatine MS Ohman EM Cannon CP Braunwald E 《American heart journal》2006,151(2):360-366
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There is a substantial need for a diagnostic tool to aid in the early diagnosis of heart failure and in the recognition of those at risk for its development, as well as in guidance of therapy. Testing for amino-terminal pro-brain natriuretic peptide (NT-proBNP) has been recognized to have utility in the diagnosis, prognosis and management of heart failure. In addition, numerous other applications for NT-proBNP testing are now recognized, such as evaluation of patients with heart disease in the absence of heart failure, as well as the diagnostic and prognostic evaluation of patients with acute coronary syndromes or pulmonary thromboembolism. 相似文献
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Parul U. Gandhi Sheryl L. Chow Thomas S. Rector Henry Krum Hanna K. Gaggin John J. McMurray Michael R. Zile Michel Komajda Robert S. McKelvie Peter E. Carson James L. Januzzi Inder S. Anand 《Journal of cardiac failure》2017,23(1):20-28
Background
The prognostic merit of insulin-like growth factor-binding protein 7 (IGFBP7) is unknown in heart failure and preserved ejection fraction (HFpEF).Methods and Results
Baseline IGFBP7 (BL-IGFBP7; n?=?302) and 6-month change (Δ; n?=?293) were evaluated in the Irbesartan in Heart Failure and Preserved Ejection Fraction (I-PRESERVE) trial. Primary outcome was all-cause mortality or cardiovascular hospitalization with median follow-up of 3.6 years; secondary outcomes included HF events. Median BL-IGFBP7 concentration was 218?ng/mL. BL-IGFBP7 was significantly correlated with age (R2?=?0.13; P?<?.0001), amino-terminal pro-B-type NP (R2?=?0.22; P?<?.0001), and estimated glomerular filtration rate (eGFR; R2?=?0.14; P?<?.0001), but not with signs/symptoms of HFpEF. BL-IGFBP7 was significantly associated with the primary outcome (hazard ratio [HR]?=?1.007 per ng/mL; P?<?.001), all-cause mortality (HR?=?1.008 per ng/mL; P?<?.001), and HF events (HR?=?1.007 per ng/mL; P?<?.001). IGFBP7 remained significant for each outcome after adjustment for ln amino-terminal pro-B-type NP and eGFR but not all variables in the I-PRESERVE prediction model. After 6 months, IGFBP7 did not change significantly in either treatment group. ΔIGFBP7 was significantly associated with decrease in eGFR in patients randomized to irbesartan (R2?=?0.09; P?=?.002). ΔIGFBP7 was not independently associated with outcome.Conclusions
Higher concentrations of IGFBP7 were associated with increased risk of cardiovascular events, but after multivariable adjustment this association was no longer present. Further studies of IGFBP7 are needed to elucidate its mechanism.250.