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Myocardial Infarction Stabilization

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3301. N-terminal proatrial natriuretic factor. An independent predictor of long-term prognosis after myocardial infarction. (Abstract)

N-terminal proatrial natriuretic factor. An independent predictor of long-term prognosis after myocardial infarction. Atrial natriuretic factor (ANF) is a peptide hormone secreted from cardiac atria in response to increased atrial pressure. Because of a longer half-life and greater stability, the N-terminal of ANF prohormone (N-terminal proANF) may be a better integrator of atrial peptide secretion than ANF itself. After myocardial infarction, elevation of ANF and other neurohormones has been (...) associated with a poor prognosis. However, when left ventricular ejection fraction (LVEF) and other important clinical variables are included in multivariate analysis, the independent predictive value of these neurohormones has been reduced markedly.To test the prognostic value of N-terminal proANF after myocardial infarction, its plasma concentration was measured a mean of 12 days after infarction in 246 patients in the Survival and Ventricular Enlargement (SAVE) Study. N-terminal proANF was a much

1994 Circulation

3302. Influence of acute alpha 1-adrenergic antagonism on heart rate variability in patients with old myocardial infarction. (Abstract)

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

3303. Assessment of therapeutic quality control in a long-term anticoagulant trial in post-myocardial infarction patients. (Abstract)

. 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

3304. [The vertebrogenic aspect of hemodynamic adaptive differences in relation to the presence of concomitant arterial hypertension in patients with a history of myocardial infarct]. (Abstract)

specific features of formation of the phenomenon of structural adaptative stabilization (SAS). There were hemodynamic variations to a single procedure of manual therapy in relation to the extent of cardiac lesion. The single procedure of manual therapy was found to affect the patients with myocardial infarction concurrent with arterial hypertension and to transfer the latters to the general myocardial patient population without arterial hypertension. The manual impact on the vertebrogenic links (...) [The vertebrogenic aspect of hemodynamic adaptive differences in relation to the presence of concomitant arterial hypertension in patients with a history of myocardial infarct]. A total of 46 patients who had sustained myocardial infarction, including those with concurrent arterial hypertension were examined at polyclinic rehabilitation. The patients with myocardial infarction and those with myocardial and concurrent arterial hypertension proved to belong to various general populations having

1995 Voprosy kurortologii, fizioterapii, i lechebnoÄ­ fizicheskoÄ­ kultury

3305. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide. (Abstract)

Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide. Elevated plasma levels of atrial natriuretic peptide (ANP) and the N-terminal fragment of the ANP prohormone (N-ANP) are associated with decreased left ventricular function and decreased long-term survival after acute myocardial infarction (AMI). Previous (...) prognostic indicators used in risk stratification after AMI because of its strong, independent association with long-term survival, enhanced in vitro stability, and simplicity of analysis.

1996 Circulation

3306. Patient and doctor delay in acute myocardial infarction: a study in Rotterdam, The Netherlands. Full Text available with Trip Pro

more than 82 minutes. The ambulance arrived within 15 minutes in 90% of all 242 cases, while the time required for stabilization of the patient by the ambulance staff and transport to the hospital took a median of 15 minutes.Compared with earlier studies, patients with a myocardial infarction called for help sooner. However, it may take a considerable time before the general practitioner refers the patient to hospital. Further research is needed to design measures which will improve the diagnostic (...) Patient and doctor delay in acute myocardial infarction: a study in Rotterdam, The Netherlands. Early thrombolytic therapy for patients having a myocardial infarct size and improves survival.A study was undertaken to examine the components of pre-hospital delay in patients with retrospectively proven myocardial infarction.Data were gathered from 300 patients with a documented myocardial infarction admitted to three hospitals in Rotterdam, the Netherlands. Interviews were carried out

1995 The British Journal of General Practice

3307. General practitioners and emergency treatment for patients with suspected myocardial infarction: last chance for excellence? Full Text available with Trip Pro

the ambulance service but bypasses the general practitioner. Since the majority of telephone calls from people with suspected myocardial infarction are directed to general practitioners, a preferable alternative would be a 'stay and stabilize' strategy that uses the existing referral pattern and builds on general practitioners' medical education and skills. The role of the general practitioner in the management of patients with suspected myocardial infarction is discussed. (...) General practitioners and emergency treatment for patients with suspected myocardial infarction: last chance for excellence? Pre-hospital coronary care usually consists of a medically staffed coronary care ambulance going into the community from a hospital base, as pioneered in Northern Ireland. In today's medicopolitical and economic climate, this model is not viable in mainland United Kingdom. Current proposals seem to favour a 'scoop and run' policy for heart attack victims, that utilizes

1992 The British Journal of General Practice

3308. Radiofrequency ablation of haemodynamically unstable ventricular tachycardia after myocardial infarction Full Text available with Trip Pro

Radiofrequency ablation of haemodynamically unstable ventricular tachycardia after myocardial infarction To determine whether radiofrequency (RF) ablation might have a role in haemodynamically unstable ventricular tachycardia.10 patients with a history of ventricular tachycardia producing haemodynamic collapse in whom drug treatment had failed and device therapy was rejected underwent RF ablation of ventricular tachycardia in sinus rhythm. The arrhythmogenic zone was defined on the basis (...) stability. There were no clinical events during a mean (SD) follow up period of 23 (10) months in any of the nine patients defined as definite or possible successes.RF ablation for addressing haemodynamically unstable ventricular tachycardia opens the door for the wider use of catheter ablation for treating this arrhythmia.

2000 Heart

3309. The angiotensin converting enzyme inhibitor perindopril improves survival after experimental myocardial infarction in pigs. (Abstract)

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

3310. Is survival in acute myocardial infarction related to thrombolytic efficacy or the open-artery hypothesis? A controversy to be investigated with GUSTO. (Abstract)

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

3311. The effect of statin therapy on ventricular late potentials in acute myocardial infarction. (Abstract)

cardiovascular event rates were also lower in statin group.Early use of pravastatin reduces the incidence of late potentials following thrombolytic therapy in acute myocardial infarction. Statin therapy also seems to be reducing the incidence of in-hospital ventricular arrhythmias. These beneficial effects of statins might be explained through prevention of new myocardial ischemic episodes due to early plaque stabilization or regulation of endothelial and platelet functions. (...) The effect of statin therapy on ventricular late potentials in acute myocardial infarction. To determine whether early statin therapy in acute myocardial infarction has any effect on ventricular late potentials which are considered as a noninvasive tool for evaluation of arrhythmogenic substrate.Study population consisted of prospectively enrolled 72 patients presenting with acute myocardial infarction (<6 h). Thirty-four of the patients were randomized to pravastatin (40 mg/day) on admission

2003 International journal of cardiology Controlled trial quality: uncertain

3312. ST segment resolution in ASSENT 3: insights into the role of three different treatment strategies for acute myocardial infarction. (Abstract)

ST segment resolution in ASSENT 3: insights into the role of three different treatment strategies for acute myocardial infarction. ASSENT 3 (Assessment of the Safety and Efficacy of a New Thrombolytic) demonstrated that the bolus fibrinolytic tenecteplase (TNK), combined with enoxaparin (ENOX) or abciximab (ABCX), substantially reduced ischemic complications of acute myocardial infarction as compared with unfractionated heparin (UH). We compared ST resolution in each of the three treatment (...) in reinfarction. Thirty day and one year mortality was greatest amongst those patients with <30% ST segment resolution in the TNK/ABCX group.More rapid and complete ST resolution occurs with half-dose TNK/ABCX whereas less reinfarction occurs amongst those patients with > or =70% ST resolution receiving either TNK/ABCX or TNK/ENOX. These data highlight two potentially complementary mechanisms of clinical benefit associated with different pharmacologic regimens in acute myocardial infarction, i.e. more rapid

2003 European heart journal Controlled trial quality: uncertain

3313. Comparison of enoxaparin versus unfractionated heparin in patients with unstable angina pectoris/non-ST-segment elevation acute myocardial infarction having subsequent percutaneous coronary intervention. (Abstract)

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

3314. Low-molecular-weight heparins in acute myocardial infarction: rationale and results of a pilot study. (Abstract)

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

3315. Quality of life after balloon angioplasty or stenting for acute myocardial infarction. One-year results from the Stent-PAMI trial. (Abstract)

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

3316. Effects of intracoronary low-dose enalaprilat as an adjunct to primary percutaneous transluminal coronary angiography in acute myocardial infarction. (Abstract)

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

3317. Platelet activation in patients after an acute coronary syndrome: results from the TIMI-12 trial. Thrombolysis in Myocardial Infarction. (Abstract)

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

3318. Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial. (Abstract)

Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial. The goal of this study was to describe the core laboratory angiographic findings of "SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK" (SHOCK) trial participants and to determine the relationship of angiographic parameters to one-year survival.In the SHOCK trial, emergency revascularization improved one-year survival (...) with one-year survival in both treatment groups (p < 0.001). In the IMS group, the hazard ratio for death was 2.59 (95% confidence interval 1.47 to 4.58, p = 0.001) per diseased vessel (0/1 vs. 2 vs. 3). In the ERV group, the hazard ratio for death per diseased vessel was 1.11 (95% confidence interval 0.79 to 1.56, p = 0.559). Multivariate analysis of the angiography cohort (without regard for left ventriculogram measurements) identified initial Thrombolysis in Myocardial Infarction flow grade (p

2003 Journal of the American College of Cardiology Controlled trial quality: uncertain

3319. Parasympathetic failure and risk of subsequent coronary events in unstable angina and non-ST-segment elevation myocardial infarction. (Abstract)

Parasympathetic failure and risk of subsequent coronary events in unstable angina and non-ST-segment elevation myocardial infarction. Previous animal studies suggested that vagal tone contributes to tonic dilatation of coronary arteries. We hypothesized that low parasympathetic activity might be among the causes of coronary instability in the setting of acute coronary syndrome without ST-segment elevation.We studied 172 consecutive patients. Vagal and sympathetic activities were assessed (...) pNN50 <3%, 18 patients (72%) had subsequent coronary events vs seven patients (28%) who had a good outcome.These data show that in acute coronary syndrome without ST-segment elevation, a significant number of patients developing subsequent coronary events have a loss of vagal tone. Simple electrocardiographic variables, as pNN50 <3%, may be of great clinical value in identifying patients at high risk of subsequent coronary events even after apparent clinical stabilization.

2003 European Heart Journal

3320. Short- and long-term hemodynamic effects of intra-aortic balloon support in ventricular septal defect complicating acute myocardial infarction. (Abstract)

Short- and long-term hemodynamic effects of intra-aortic balloon support in ventricular septal defect complicating acute myocardial infarction. In patients with an infarct-related ventricular septal defect, an intra-aortic balloon pump provides immediate and long-term hemodynamic improvement, resulting in an enhanced effective cardiac output and a reduced left-to-right-shunt and shunt flow ration. In patients who can be stabilized or remain stable, there is no habituation to the effects

2003 American Journal of Cardiology

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