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Myocardial Infarction Stabilization

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3161. Continuous infusions of alfentanil and propofol for coronary artery surgery. (Abstract)

) and in the number of alfentanil bolus supplements. There were also no differences in the incidence of ischemia, myocardial infarction or duration of postoperative ventilation.Because both infusions provided equally stable anesthesia, the lower infusion regimen for alfentanil is the more appropriate technique. Using this technique, the administration of additional alfentanil boluses just before stressful surgical episodes will further improve hemodynamic stability. (...) Continuous infusions of alfentanil and propofol for coronary artery surgery. To study the anesthetic efficacy of two different background infusion rates for alfentanil in a total intravenous anesthesia (TIVA) technique using propofol. Therefore, the effects of these infusions on hemodynamic stability and on the suppression of hemodynamic and somatic responses to noxious stimuli were compared.Prospective and randomized.The study was performed in a university hospital setting. Two patient groups

1995 Journal of cardiothoracic and vascular anesthesia Controlled trial quality: uncertain

3162. [Limitation of atherosclerosis in coronary arteries with pravastatin (PLAC 1)]. (Abstract)

, significant impact was seen in the area of clinical events, particularly fatal and nonfatal myocardial infarctions. The latter were significantly reduced in the treated patients. These results were paralleled by a significant slowing of progression in the treated patients. Importantly, the angiographic effects were predominant in prevention of new lesion formation and in slowing the progression of mild/moderate lesions less than 50% diameter stenosis at baseline. Current concepts suggest that the latter (...) two categories of lesions are the most important in linking angiographic outcomes with clinical events. PLAC 1 is the first trial to concomitantly show statistically significant effects in clinical end points and angiographic end-points in the category of new and/or mild stenoses. These results are compatible with the concept of plaque stabilization.

1995 Revista española de cardiología Controlled trial quality: predicted high

3163. [Medical therapy for coronary heart disease. Perioperative relevance]. (Abstract)

% have perioperative myocardial ischaemia (PMI), the majority being non-symptomatic. This figure correlates with the occurrence of postoperative cardiac complications and myocardial infarction. The anaesthetist therefore has an important role to play in reducing the rate of perioperative cardiac sequelae. This can be achieved with good control of haemodynamic stability and the timely and appropriate use of antiischaemic drugs. Nitrocompounds (nitrates, molsidomine) serve as the gold standard (...) of perioperative tachycardia, hypertension, and PMI. Consequently, such one-time medication can be considered for previously untreated high-risk patients presenting for surgery. The continuation of oral calcium channel blockers to the morning of surgery also reduces the rate of PMI and myocardial infarction in coronary-bypass patients, and combination with beta-blockers enhances this effect. Intra-operative diltiazem infusions are similarly advantageous in this patient group. In addition to nitrates, calcium

1994 Der Anaesthesist Controlled trial quality: uncertain

3164. Tissue plasminogen activator using a rapid-infusion low-dose regimen for unstable angina. (Abstract)

patients were treated with aspirin, twice-daily subcutaneous heparin, and maximally tolerated antianginal therapy. Of the 50 patients assigned, 26 received rt-PA and the outcome was successful in 15 (58%) (angina settled, no myocardial infarction or urgent intervention) compared with 9 (38%) successful outcomes in the 24 who received placebo (0.5 greater than p greater than 0.1). Angina remained refractory in 8 (31%) of the rt-PA group and in 13 (54%) of the placebo group (0.1 greater than p greater (...) than 0.05). Urgent interventions were required in 6 patients (23%) who received rt-PA and in 11 patients (46%) who received placebo. Three patients in each group sustained a myocardial infarction within 72 hours of entering the trial and there were 3 deaths (1 in the active treatment group, 2 in placebo group) within 2 weeks of the trial (p = not significant). Administration of intravenous rt-PA was not associated with any complications. Low-dose rt-PA administration in patients with unstable

1992 The American journal of cardiology Controlled trial quality: uncertain

3165. A randomized comparison of exercise training in patients with normal vs reduced ventricular function. (Abstract)

A randomized comparison of exercise training in patients with normal vs reduced ventricular function. Exercise training is recommended after myocardial infarction (MI) or bypass surgery in order to improve exercise tolerance. In some patients, the decrement in exercise capacity secondary to deconditioning and the left ventricular stunning associated with MI or coronary artery bypass graft (CABG) spontaneously improves after the event. However, the impact of the status of the left ventricle (...) on these improvements is unknown.Sixty-seven patients 1 month after MI or CABG were randomized to a training (n=34; age, 59+/-7 years) or a control group (n=33; age, 55+/-6 years). Forty-two patients had an ejection fraction >50% (22 in the training group and 20 in the control group), and 25 patients had an ejection fraction <40% (12 in the exercise group and 13 in the control group). After stabilization for approximately 1 month after the event, patients in the exercise group underwent 8 weeks of twice daily

1998 Chest Controlled trial quality: uncertain

3166. Effective arterial elastance and the hemodynamic effects of intraaortic balloon counterpulsation in patients with coronary heart disease. (Abstract)

) incorporates the principal elements of input arterial impedance and has been proved useful to evaluate the effects of afterload reduction in patients with left ventricular (LV) failure. However, although the hemodynamic action of IABC can be considered as a typical example of "pure" afterload reduction, it has never been assessed in terms of changes in Ea.After clinical stabilization, 18 patients treated with IABC for complicated acute myocardial infarction or unstable angina were enrolled in the study

1998 American heart journal Controlled trial quality: uncertain

3167. Comparative efficacy of the intravenous administration of linsidomine, a direct nitric oxide donor, and isosorbide dinitrate in severe unstable angina. A French multicentre study. French Group of Investigators. (Abstract)

dinitrate groups, P = 0.48). The incidence of serious clinical events at 72 h (death, myocardial infarction or myocardial revascularization) was 6.5% (5% vs 8% in the linsidomine and isosorbide dinitrate groups, P = 0.17).Intravenous linsidomine is at least as efficacious as isosorbide dinitrate in the stabilization of patients with severe unstable angina. (...) . Only 25% of the patients had at least one episode of chest pain during the study (24.6% vs 25.8% in the linsidomine and isosorbide dinitrate groups, P = 0.74), of which 12% were associated with ECG changes. Holter criteria yielded similar results in both groups: 33% of patients presented episodes of myocardial ischaemia (32.6% vs 33.9% in the linsidomine and isosorbide dinitrate groups, P = 0.74), while 45% showed episodes of ventricular arrhythmia (43.5% vs 46.5% in the linsidomine and isosorbide

1997 European heart journal Controlled trial quality: uncertain

3168. Coronary artery bypass grafting without cardiopulmonary bypass using the octopus method: results in the first one hundred patients. (Full text)

, on average 23 in the full access group (46 patients) and 1.2 in the limited access group (54 patients). Complications included conversion to cardiopulmonary bypass (2%), conversion from limited to full access (3%), myocardial infarction (4%), predischarge coronary reintervention (2%), and late coronary reintervention (1%). Median postoperative length of hospital stay was 4 days (limited access) or 5 days (full access). Rapid recovery allowed 96% of patients to resume social activities within 1 month (...) prospectively assessed the safety and efficacy of the Octopus tissue stabilizer (Medtronic, Inc., Minneapolis, Minn.) in the first 100 patients selected for off-pump coronary bypass via full or limited surgical access. To immobilize and expose the coronary artery, two suction paddles (-400 mm Hg), fixed to the operating table-rail by an articulating arm, stabilized the anastomosis site.One hundred forty-one grafts (96% arterial) were used to create 172 anastomoses (17% side-to-side), up to 4 per patient

1998 The Journal of thoracic and cardiovascular surgery PubMed abstract

3169. Clinical characteristics and current management of medically refractory unstable angina. (Full text)

ejection fractions (EF) of less than 0.40. Twenty-four patients were greater than 65 years of age, and 53 had associated major diseases. Forty-eight patients (Group I) had no evidence of myocardial infarction in the 30 days before catheterization, whereas 52 patients had an infarction precipitating the unstable angina within the preceding 30 days (Group II). Emergent coronary artery bypass grafting was performed in all 100 patients irrespective of ventricular function, hemodynamic status, or coronary (...) anatomy. Management protocols included prompt surgical intervention, preoperative stabilization with the balloon pump in LM or TVD, meticulous myocardial protection, and complete coronary revascularization. An average of 3.6 grafts were placed in each patient. There were two hospital deaths in Group I, and two in Group II. Two-year survival was 90% in Group I and 88% in Group II, and 81% of surviving patients were NYHA Class I or II. Thus, refractory UA denotes particularly severe coronary disease

1984 Annals of Surgery PubMed abstract

3170. Mechanical Circulatory Assist Devices (Full text)

be weaned from circulatory support. Patients suffering cardiogenic shock due to acute myocardial infarction can be stabilized with circulatory assist for medical and surgical treatment. In addition, mechanical circulatory assist devices can serve as a bridge for patients awaiting cardiac transplantation. (...) Mechanical Circulatory Assist Devices Cardiogenic shock occurs in about 10% of the 1.5 million patients who suffer myocardial infarction and in approximately 1% of the 200,000 patients who undergo open-heart surgery each year. The ventricular assist device decreases the workload of the failing ventricles and increases the blood flow through the coronary system. Recovery of failing myocardium after mechanical circulatory assistance has been well documented; however, the mechanisms

1987 Texas Heart Institute Journal PubMed abstract

3171. Influence of projected complication rates on estimated appropriate use rates for carotid endarterectomy. Appropriateness Project Investigators. Academic Medical Center Consortium. (Full text)

of appropriateness, three different definitions of risk strata for combined perioperative death or stroke were used: Definition A, low risk < 3 percent; Definition B, low risk < 5 percent; and Definition C, low risk < 7 percent.Overall hospital-specific mortality ranged from 0 percent to 4.0 percent and major complications, defined as death, stroke, intracranial hemorrhage, or myocardial infarction, varied from 2.0 percent to 11.1 percent. Most patients (72 percent) had surgery for transient ischemic attack (...) such "appropriateness" ratings, it is crucial to perform sensitivity analyses in order to assess the stability of the results. Results that are robust to moderate in variation in surgical risk provide a much sounder basis for policy making than those that are not.

1997 Health Services Research PubMed abstract

3172. Risk stratification by early exercise testing after an episode of unstable coronary artery disease. The RISC Study Group. (Abstract)

Risk stratification by early exercise testing after an episode of unstable coronary artery disease. The RISC Study Group. After stabilization of symptoms by medication a predischarge exercise test was performed in 855 men admitted with suspected unstable angina (54%) or non-Q-wave myocardial infarction (46%). Multiple logistic regression analysis demonstrated that the number of leads with ST-depression at exercise, low maximal work load, increasing age and ST-elevation in electrocardiogram (...) at rest had independent prognostic value concerning the risk of myocardial infarction or death during the following year. Therefore a combination of extension of ST-depression and peak work load was used to define 'high and low risk response' at the exercise test. After 1 year the mortality in patients with 'high risk' compared to 'low risk' exercise response was 3.6% and 0% (P < 0.001) and the risk of either myocardial infarction or death was 15.4% and 3.9% (P < 0.0001), respectively. ST-depression

1993 International journal of cardiology Controlled trial quality: uncertain

3173. Beneficial effects from beta-adrenergic blockade in elderly patients undergoing noncardiac surgery. (Abstract)

Beneficial effects from beta-adrenergic blockade in elderly patients undergoing noncardiac surgery. Perioperative beta-blockade has been shown to improve long-term cardiac outcome in noncardiac surgical patients. A possible mechanism for the reduced risk of perioperative myocardial infarction is the attenuation of the excitotoxic effects of catecholamine surges by beta-blockade. It was hypothesized that beta-blocker-induced alteration of the stress response was responsible for the reported (...) ). Three patients in group I had cardiac troponin I levels consistent with myocardial infarction.Beta-blockade does not reduce the neuroendocrine stress response, suggesting that this mechanism is not responsible for the previously reported improved cardiovascular outcome. However, it confers several advantages, including decreased analgesic requirements, faster recovery from anesthesia, and improved hemodynamic stability. The release of cardiac troponin I suggests the occurrence of perioperative

1999 Anesthesiology Controlled trial quality: uncertain

3174. Early symptom-limited exercise test for risk stratification in post menopausal women with unstable coronary artery disease. FRISC study group. Fragmin during Instability in Coronary Artery Disease. (Full text)

the exercise test and 9% of the 395 women who did, died or had a myocardial infarction (P<0.01). Multivariate stepwise logistic regression analysis was performed to assess the value of clinical variables and findings at the predischarge exercise test to predict cardiac events. Based on the exercise test results three risk groups were identified with an event rate of 19%, 9% and 1%, respectively. The exercise test was better than any of the tested clinical variables in predicting cardiac events.Women (...) in the analysis. The aim of the study was to evaluate an early symptom-limited exercise test as a tool for risk stratification in women with unstable coronary artery disease admitted to the coronary care unit.Of the 543 women in the FRISC I study, 395 stabilized on medical treatment and performed a symptom-limited exercise test 5-8 days after inclusion. Sixteen patients with a cardiac event before the scheduled exercise test were excluded. During the 6 months follow-up 17% of the women who did not perform

2000 European heart journal Controlled trial quality: uncertain PubMed abstract

3175. Is hyperuricemia a risk factor of stroke and coronary heart disease among Africans? (Abstract)

Is hyperuricemia a risk factor of stroke and coronary heart disease among Africans? Uric acid stabilizes platelet aggregation and enhances thrombotic tendency.To examine the relationship between raised serum uric acid and subsequent cardiovascular events (mortality, myocardial infarction, stroke).This is a longitudinal study in a small random number (418) of patients in Kinshasa, Congo. In this hospital-based study, uricemia was determined with respect to gender, obesity and hypertension (...) ) in patients with hyperuricemia than in those with normal serum uric acid. Serum uric acid was significantly correlated with body weight, BP, glucose, fibrinogen, urea, creatinin and total cholesterol. In men, hyperuricemia was significantly (P<0.01) associated with a twofold increased risk of both myocardial infarction and stroke incidence. However, hyperuricemia was significantly related to a double risk of all mortality and stroke onset.Our results indicate that hyperuricemia among african patients

1999 International journal of cardiology

3176. Percutaneous coronary intervention versus coronary bypass graft surgery for diabetic patients with unstable angina and risk factors for adverse outcomes with bypass: outcome of diabetic patients in the AWESOME randomized trial and registry. (Abstract)

randomized trial and registry of high-risk patients.Previous studies indicate that CABG may be superior to PCI for diabetics, but no comparisons have been made for diabetics at high risk for surgery.Over five years (1995 to 2000), 2,431 patients with medically refractory myocardial ischemia and at least one of five risk factors (prior CABG, myocardial infarction within seven days, left ventricular ejection fraction <0.35, age >70 years, or an intra-aortic balloon being required to stabilize) were

2002 Journal of the American College of Cardiology Controlled trial quality: uncertain

3177. Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock. (Abstract)

Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock. Although echocardiography is used in diagnosis and management of myocardial infarction, it has not been established whether specific features of cardiac structure or function early in the course of cardiogenic shock provide prognostic value. The purposes of this substudy of the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) trial were to describe (...) the echocardiographic features of cardiogenic shock, identify findings on early echocardiograms associated with outcome, examine the interaction of such features with treatment, and determine whether these features could provide insights into the survival benefit observed with early revascularization and guide selection of patients for this strategy.One hundred seventy-five echocardiograms performed within 24 hours of randomization to the early revascularization (ERV) or initial medical stabilization (IMS) arms

2003 Circulation Controlled trial quality: uncertain

3178. Effect of sevoflurane on the ex vivo secretion of TNF-alpha during and after coronary artery bypass surgery. (Abstract)

of cardiopulmonary bypass (median (interquartiles): 25 (21-30) versus 37 (28-79) pg mL(-1); P < 0.05) and 24h after skin closure (196 (100-355) versus 382 (233-718) pg mL(-1); P < 0.05). Postoperatively, two cases of myocardial infarction were recorded, one in each group. Six patients in Group 2 needed continued inotropic support after the first morning to maintain haemodynamic stability versus one patient in Group 1 (P < 0.05). The length of stay in the intensive care unit was significantly lower in Group 1 (...) Effect of sevoflurane on the ex vivo secretion of TNF-alpha during and after coronary artery bypass surgery. Sevoflurane has been used for the induction and maintenance of anaesthesia during cardiac surgery owing to its favourable haemodynamic effects. It has been suggested that it offers protection against myocardial ischaemia-reperfusion injury.We investigated the effect of sevoflurane on plasma concentrations of tumour necrosis factor-alpha (TNF-alpha) after ex vivo stimulation of whole

2003 European Journal of Anaesthesiology Controlled trial quality: uncertain

3179. Remifentanil, fentanyl, and cardiac surgery: a double-blinded, randomized, controlled trial of costs and outcomes. (Abstract)

of hypertension but a frequent rate of hypotension (P < 0.01). The urinary cortisol excretion was larger in Group FLD patients (P < 0.0005), and urine flow was smaller (P < 0.0005). Remifentanil was associated with a propofol dose reduction (P = 0.0005) and a concomitant higher bispectral index (P = 0.032). Three Group FLD patients, but none in groups FMD and R, had postoperative myocardial infarctions (P = 0.032). Remifentanil has larger drug acquisition costs but does not increase the total hospital costs (...) ) were associated with a decreased rate of myocardial infarction after cardiac surgery.

2002 Anesthesia and analgesia Controlled trial quality: predicted high

3180. Cardiogenic shock: a summary of the randomized SHOCK trial. (Abstract)

Cardiogenic shock: a summary of the randomized SHOCK trial. Cardiogenic shock is the most common cause of death for patients hospitalized with acute myocardial infarction. The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial randomly assigned 302 patients with predominant left ventricular failure following an acute myocardial infarction to a strategy of emergency revascularization or initial medical stabilization. Emergency revascularization by either (...) , there was a significant survival benefit with early revascularization (50% vs. 37%; p=0.027 and 47% vs. 34%; p=0.025, respectively). The benefit appeared to be greatest for those less than 75 years of age, with 20 lives saved at 6 months per 100 patients treated. According to the results of the SHOCK trial, the American College of Cardiology/American Heart Association guidelines for myocardial infarction now recommend emergency revascularization for patients younger than 75 years with cardiogenic shock.Copyright 2003

2003 Congestive heart failure (Greenwich, Conn.) Controlled trial quality: uncertain

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