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Myocardial Infarction Stabilization

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3261. Clinical intervention studies on magnesium in myocardial infarction. (PubMed)

Clinical intervention studies on magnesium in myocardial infarction. Patients with acute myocardial infarction (AMI) display a significant decrease in serum magnesium concentrations (S-Mg,c) during the initial 48 h after infarction. This decrease is not due to an increased renal magnesium loss, neither is it a dilution phenomenon. Consequently, a migration of Mg from the extracellular to intracellular space might take place, which probably is due to a catecholamine-induced increased lipolysis (...) , forming insoluble intracellular Mg soaps. As the Mg ion is crucial in maintaining the electrical stability of the myocardium, we found it rational to avoid this postinfarctional hypomagnesemia by administration of Mg. In a double-blind, placebo-controlled trial, 130 patients with AMI were randomly allocated to receive a total of 62 mmol magnesium chloride or placebo intravenously during the initial 48 h in hospital. Mg treatment was associated with a reduction in the acute mortality from 19

1989 Magnesium Controlled trial quality: predicted high

3262. Should the exercise test (ET) be performed at discharge or one month later after an episode of unstable angina or non-Q-wave myocardial infarction? (PubMed)

Should the exercise test (ET) be performed at discharge or one month later after an episode of unstable angina or non-Q-wave myocardial infarction? The diagnostic and prognostic value of symptom limited exercise tests (ET) performed before discharge and after one month were compared in men admitted to hospital after an episode of unstable angina or a non-Q-wave myocardial infarction (MI). A 'Positive ET' was defined as either a maximal work load below 100 W or ST-depression greater than (...) stabilized after an episode of unstable angina or non-Q-wave MI.

1991 International journal of cardiac imaging Controlled trial quality: uncertain

3263. Is survival in acute myocardial infarction related to thrombolytic efficacy or the open-artery hypothesis? A controversy to be investigated with GUSTO. (PubMed)

was achieved in a time frame beyond that in which myocardial salvage could be expected. The "open-artery hypothesis" suggests that survival may be more dependent on improved left ventricular remodeling and healing, increased electrical stability, and better myocardial perfusion than on infarct size reduction. In an attempt to determine whether 90-min patency or 24-h patency is more predictive of survival, the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) trial (...) Is survival in acute myocardial infarction related to thrombolytic efficacy or the open-artery hypothesis? A controversy to be investigated with GUSTO. The reduction in morbidity and mortality associated with thrombolytic therapy in patients with acute myocardial infarction was initially attributed to early restoration of arterial patency, salvage of ischemic myocardium, and preservation of left ventricular function. Recombinant tissue plasminogen activator (rt-PA) was initially the favored

1992 Chest Controlled trial quality: uncertain

3264. The angiotensin converting enzyme inhibitor perindopril improves survival after experimental myocardial infarction in pigs. (PubMed)

The angiotensin converting enzyme inhibitor perindopril improves survival after experimental myocardial infarction in pigs. In this randomized, blinded study the effect of the angiotensin converting enzyme inhibitor perindopril on electrical stability after myocardial infarction in pigs was compared to placebo. The left anterior descending artery was occluded for 45 min. Perindoprilat (0.06 mg/kg, n = 12) or saline (n = 12) was injected 15 min before reperfusion. Treatment was continued till (...) was comparable between survivors. The latter indicates that a comparable electrical stability 2 weeks after myocardial infarction is obtained in perindopril-treated pigs at a significantly higher survival rate.

1992 Journal of cardiovascular pharmacology Controlled trial quality: uncertain

3265. Influence of acute alpha 1-adrenergic antagonism on heart rate variability in patients with old myocardial infarction. (PubMed)

Influence of acute alpha 1-adrenergic antagonism on heart rate variability in patients with old myocardial infarction. Decreased heart rate (HR) variation is a predictor of cardiac and arrhythmic death after myocardial infarction (MI). The present study examined the influence of alpha-adrenergic system on HR variation (HRV). A novel alpha 1-adrenergic antagonist, abanoquil (UK 52,046) was administered acutely to 27 patients with old MI in random placebo-controlled cross-over design. Abanoquil (...) changes in HRV were related by covariate analysis to the decrease in sinus interval and were not associated with an orthostatic decrease in blood pressure (BP) induced by abanoquil. The dominant effect of acute alpha 1-adrenergic antagonism appears to be a decrease in parasympathetic activity, although it may also stabilize sympathetic control of the heart. Thus, the autonomic nervous modification caused by alpha-adrenoceptor antagonists might be disadvantageous in treatment of patients at high risk

1994 Journal of cardiovascular pharmacology Controlled trial quality: uncertain

3266. Assessment of therapeutic quality control in a long-term anticoagulant trial in post-myocardial infarction patients. (PubMed)

. The study population comprised 1700 post myocardial infarction patients. Treatment comprised 3725 patient-years. There were 61,471 INR assessments with target therapeutic level of 2.8-4.8. Acenocoumarol as well as phenprocoumon were employed. Therapeutic achievement in the first months of treatment was low: less than 60% of INR's were in range. Treatment stabilized after 6 months. Patients on acenocoumarol were within range 70% of the time compared to 80% for phenprocoumon. Method 3 is preferred because (...) Assessment of therapeutic quality control in a long-term anticoagulant trial in post-myocardial infarction patients. Various methods have been described to evaluate efficacy of anticoagulant therapy using the international normalized ratio (INR). We compared the following approaches: (1) total INR's or the most recent measurement; (2) percent time within therapeutic range, with INR changing directly or halfway between visits; and (3) total observation time assuming INR changing linearly

1994 Thrombosis and haemostasis Controlled trial quality: uncertain

3267. Platelet activation in patients after an acute coronary syndrome: results from the TIMI-12 trial. Thrombolysis in Myocardial Infarction. (PubMed)

with ACS, especially in the setting of chronic glycoprotein (GP) IIb/IIIa inhibition.The Thrombolysis in Myocardial Infarction (TIMI) 12 trial was a phase II, double-blind trial evaluating the effects of sibrafiban, an oral, selective antagonist of the platelet glycoprotein IIb/IIIa receptor in patients stabilized after an ACS. A subset of 90 of the 329 patients in the study had measurement of platelet activation as assessed by the expression of platelet associated P-Selectin on days 0, 7 and 28 (...) Platelet activation in patients after an acute coronary syndrome: results from the TIMI-12 trial. Thrombolysis in Myocardial Infarction. This study was designed to determine the magnitude and time course of platelet activation during therapy of acute coronary syndromes with an oral platelet antagonist.Platelet activation and aggregation are central to the pathogenesis of the acute coronary syndromes (ACS). However, few data are available on levels of platelet activation over time in patients

1999 Journal of the American College of Cardiology Controlled trial quality: uncertain

3268. Low-molecular-weight heparins in acute myocardial infarction: rationale and results of a pilot study. (PubMed)

Low-molecular-weight heparins in acute myocardial infarction: rationale and results of a pilot study. Antithrombotic adjuncts to fibrinolytic drugs for acute myocardial infarction increase the rate and speed of infarct artery recanalization.A low-molecular-weight heparin might be preferable to unfractionated heparin for this indication, as it has been shown to be in several other thrombus-related vascular disorders.We performed a pilot study in 20 patients, all receiving aspirin and recombinant (...) tissue plasminogen activator. Randomization was to standard dose intravenous unfractionated heparin or enoxaparin (the first dose given intravenously and followed by a subcutaneous administration). The endpoint was stability of anticoagulant effect.Enoxaparin produced stable therapeutic anti-Xa levels with minimal effect on activated partial thromboplastin times. Unfractionated heparin produced wide swings of these parameters, often outside desired levels.Enoxaparin may be a better antithrombotic

2000 Clinical cardiology Controlled trial quality: uncertain

3269. Quality of life after balloon angioplasty or stenting for acute myocardial infarction. One-year results from the Stent-PAMI trial. (PubMed)

Quality of life after balloon angioplasty or stenting for acute myocardial infarction. One-year results from the Stent-PAMI trial. The goal of this study was to compare the impact of primary stenting or percutaneous transluminal coronary angioplasty (PTCA) on health-related quality of life (HRQOL) in patients undergoing direct angioplasty for acute myocardial infarction (AMI).Previous studies have demonstrated that coronary stenting reduces clinical and angiographic restenosis compared (...) with PTCA. However, the impact of stenting on HRQOL from the patient's perspective remains unknown.We administered the Seattle Angina Questionnaire and the Medical Outcomes Study Short-form Survey at 1, 6 and 12 months after initial treatment to all North American patients in the Stent-Primary Angioplasty for Myocardial Infarction trial (Stent-PAMI) (n = 509)-a randomized trial comparing primary stenting to conventional PTCA for patients with AMI.At one month, most HRQOL measures were similar

2001 Journal of the American College of Cardiology Controlled trial quality: uncertain

3270. Effects of intracoronary low-dose enalaprilat as an adjunct to primary percutaneous transluminal coronary angiography in acute myocardial infarction. (PubMed)

Effects of intracoronary low-dose enalaprilat as an adjunct to primary percutaneous transluminal coronary angiography in acute myocardial infarction. Bradykinin accumulation is a potent cardioprotective mechanism underlying angiotensin-converting enzyme (ACE) inhibition in ischemia and/or reperfusion injury. There is, however, concern about treatment with ACE inhibitors in the very early phase of acute myocardial infarction (AMI) due to adverse systemic hemodynamic effects. We tested (...) the hypothesis that cardiac bradykinin metabolism can be influenced by very low doses of intracoronary ACE inhibitors without harmful systemic effects in patients with AMI. Twenty-two patients with AMI in Killip classes II to III who underwent primary percutaneous transluminal coronary angiography (PTCA) were randomized to intracoronary enalaprilat (50 microg) or saline, given immediately after reopening of the infarct-related artery. Hemodynamics and electrocardiograms were monitored continuously

2001 The American journal of cardiology Controlled trial quality: uncertain

3271. Comparison of enoxaparin versus unfractionated heparin in patients with unstable angina pectoris/non-ST-segment elevation acute myocardial infarction having subsequent percutaneous coronary intervention. (PubMed)

Comparison of enoxaparin versus unfractionated heparin in patients with unstable angina pectoris/non-ST-segment elevation acute myocardial infarction having subsequent percutaneous coronary intervention. Patients with unstable angina or non-ST-segment elevation myocardial infarction (MI) may undergo invasive revascularization procedures shortly after admission to hospital or after a brief period of stabilization. In the Thrombolysis In Myocardial Infarction (TIMI) 11B trial and Efficacy

2002 The American journal of cardiology Controlled trial quality: uncertain

3272. Perioperative sympatholysis. Beneficial effects of the alpha 2-adrenoceptor agonist mivazerol on hemodynamic stability and myocardial ischemia. McSPI--Europe Research Group. (PubMed)

Perioperative sympatholysis. Beneficial effects of the alpha 2-adrenoceptor agonist mivazerol on hemodynamic stability and myocardial ischemia. McSPI--Europe Research Group. Mivazerol hydrochloride is a new alpha 2-adrenoceptor agonist. In vitro and animal studies have demonstrated both sympatholytic and antiischemic properties. To evaluate the safety and efficacy of mivazerol in patients during perioperative stress, this multicenter phase II clinical trial studied hemodynamic stability (...) , no rebound response occurred in the 12 h after discontinuation of mivazerol. The high-dose, low-dose, and placebo groups did not differ in the incidence of adverse cardiac outcomes (3%, 2%, and 8%, respectively) or the diagnosis of myocardial infarction (2%, 1%, and 6%, respectively).Continuous, 72-h perioperative administration of mivazerol to high-risk patients appears to be relatively safe, producing no significant hypotension or adverse events but some evidence of bradycardia not associated

1997 Anesthesiology Controlled trial quality: predicted high

3273. Noninvasive assessment of speed and stability of infarct-related artery reperfusion: results of the GUSTO ST segment monitoring study. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. (PubMed)

myocardial infarction.Rapid resolution of ST segment elevation has been suggested as a noninvasive marker of infarct-related artery patency. We expected that patients treated with accelerated recombinant tissue-type plasminogen activator (rt-PA) would show a quicker recovery than that of other patients but that those treated with streptokinase would show greater stability of recovery.ST segment monitoring was initiated in 1,067 patients within 30 min of the start of thrombolysis and continued for > 18 h (...) Noninvasive assessment of speed and stability of infarct-related artery reperfusion: results of the GUSTO ST segment monitoring study. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. The ST segment monitoring substudy of the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial compared the speed and stability of ST segment recovery among four thrombolytic strategies for acute

1995 Journal of the American College of Cardiology Controlled trial quality: uncertain

3274. [Captopril in acute myocardial infarct: its effect on infarct size and arrhythmias]. (PubMed)

[Captopril in acute myocardial infarct: its effect on infarct size and arrhythmias]. The effect of captopril on infarct size and arrhythmias was determined in a prospective, randomized, placebo-controlled double-blind study of 46 patients (9 women, 37 men; mean age 61 [38-86] years). Within 2-18 hours of entry into the study these patients received either a slow intravenous bolus injection of 2.5 or 5.0 mg captopril followed by a continuous infusion of 1.5-2.0 mg/h for a period of 48 hours (n (...) a favourable influence on infarct size and electrical stability which is additional to that provided by standard nitroglycerin treatment.

1992 Deutsche medizinische Wochenschrift (1946) Controlled trial quality: uncertain

3275. Classification of systemic therapies for potential stabilization of the vulnerable plaque to prevent acute myocardial infarction. (PubMed)

Classification of systemic therapies for potential stabilization of the vulnerable plaque to prevent acute myocardial infarction. In this editorial, a classification of systemic therapies for potential plaque stabilization of vulnerable plaque to prevent acute myocardial infarction is proposed based on both biologic plausibility (a potential mechanism to explain the effect) and clinical evidence (i.e., whether the agent reduced acute myocardial infarction in well-designed clinical trials). All

2005 American Journal of Cardiology

3276. Stabilization of hypoxia inducible factor rather than modulation of collagen metabolism improves cardiac function after acute myocardial infarction in rats. (PubMed)

Stabilization of hypoxia inducible factor rather than modulation of collagen metabolism improves cardiac function after acute myocardial infarction in rats. Prolyl hydroxylase domain-containing enzymes (PHD) hydroxylate a proline residue that controls the degradation of hypoxia inducible factor (HIF). Hypoxia inhibits this hydroxylation thus increasing HIF levels. HIF is upregulated in ischemic tissues, growing tumors and in nonischemic, mechanically stressed myocardium. Pharmacological (...) inhibition of prolyl 4-hydroxylase (P4-H) stabilizes HIF-protein in vitro and may modulate collagen turnover. The aims of this study were to investigate whether inhibition of P4-H protects myocardium against ischemia, and whether the observed effects are related to modulation of collagen metabolism or due to the stabilization of HIF.Rats were treated with a specific P4-H inhibitor (P4-HI) or vehicle starting 2 days before induction of myocardial infarction (MI). Rats were investigated 7 or 30 days after

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2006 European Journal of Heart Failure

3277. Src blockade stabilizes a Flk/cadherin complex, reducing edema and tissue injury following myocardial infarction (PubMed)

Src blockade stabilizes a Flk/cadherin complex, reducing edema and tissue injury following myocardial infarction Ischemia resulting from myocardial infarction (MI) promotes VEGF expression, leading to vascular permeability (VP) and edema, a process that we show here contributes to tissue injury throughout the ventricle. This permeability/edema can be assessed noninvasively by MRI and can be observed at the ultrastructural level as gaps between adjacent endothelial cells. Many of these gaps (...) contain activated platelets adhering to exposed basement membrane, reducing vessel patency. Following MI, genetic or pharmacological blockade of Src preserves endothelial cell barrier function, suppressing VP and infarct volume, providing long-term improvement in cardiac function, fibrosis, and survival. To our surprise, an intravascular injection of VEGF into healthy animals, but not those deficient in Src, induced similar endothelial gaps, VP, platelet plugs, and some myocyte damage. Mechanistically

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2004 Journal of Clinical Investigation

3278. Improved speed and stability of ST-segment recovery with reduced-dose tenecteplase and eptifibatide compared with full-dose tenecteplase for acute ST-segment elevation myocardial infarction. (PubMed)

Improved speed and stability of ST-segment recovery with reduced-dose tenecteplase and eptifibatide compared with full-dose tenecteplase for acute ST-segment elevation myocardial infarction. This sub-study of the Integrilin and Tenecteplase in Acute Myocardial Infarction (INTEGRITI) trial evaluated of the impact of combination reperfusion therapy with reduced-dose tenecteplase plus eptifibatide on continuous ST-segment recovery and angiographic results.Combination therapy with reduced-dose (...) fibrinolytics and glycoprotein IIb/IIIa inhibitors for ST-segment elevation myocardial infarction improves biomarkers of reperfusion success but has not reduced mortality when compared with full-dose fibrinolytics.We evaluated 140 patients enrolled in the INTEGRITI trial with 24-h continuous 12-lead ST-segment monitoring and angiography at 60 min. The dose-combination regimen of 50% of standard-dose tenecteplase (0.27 microg/kg) plus high-dose eptifibatide (2 boluses of 180 microg/kg separated by 10 min

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2004 Journal of the American College of Cardiology Controlled trial quality: uncertain

3279. Effects of glycoprotein IIb/IIIa inhibition on clinical stabilization parameters in patients with unstable angina and non-Q-wave myocardial infarction. (PubMed)

Effects of glycoprotein IIb/IIIa inhibition on clinical stabilization parameters in patients with unstable angina and non-Q-wave myocardial infarction. Glycoprotein IIb/IIIa receptor inhibition prevents the major cardiac events and improves the prognosis of patients with acute coronary syndromes. The purpose of the study was to evaluate the effects of tirofiban on clinical stabilization parameters in patients with unstable angina (UA) and non-Q-wave myocardial infarction (MI). Eighty-three (...) . Tirofiban, in addition to heparin, provides earlier clinical stability and prevents major in-hospital cardiac events in patients with UA and non-Q-wave MI as compared to heparin therapy alone.

2003 Heart and vessels Controlled trial quality: uncertain

3280. Effects of reperfusion obtained two to six months after acute myocardial infarction on myocardial electrical stabilization in patients with an occluded infarct-related coronary artery. (PubMed)

Effects of reperfusion obtained two to six months after acute myocardial infarction on myocardial electrical stabilization in patients with an occluded infarct-related coronary artery. To assess the changes in electrical stability markers in patients with previous myocardial infarction after very late reopening of the infarct-related artery, we studied QT dispersion, corrected-QT dispersion, and late potentials before and 1, 3, and 6 months after an attempt at late percutaneous coronary (...) after ST-elevation myocardial infarction confers significant electrical stabilization that may contribute to a better outcome in patients with patent infarct-related arteries.

2005 American Journal of Cardiology

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