The American journal of cardiology
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Predictors of and outcomes of early thrombosis following balloon angioplasty versus primary stenting in acute myocardial infarction and usefulness of abciximab (the CADILLAC trial).
We sought to identify the predictors and clinical outcomes of early thrombosis after primary angioplasty and stenting for acute myocardial infarction (AMI). Little is known about the correlates and prognosis of acute and subacute thromboses after percutaneous coronary intervention (PCI) for AMI. We therefore studied the frequency, clinical determinants, and implications of early thrombosis in a large trial of patients who had primary PCI. ⋯ Patients who develop early thrombosis after primary PCI have a very high rate of major adverse cardiac events, including death and reinfarction, and usually require repeat coronary angioplasty or surgery for management. Complex baseline angiographic morphology and smaller maximal balloon diameter are predictors of early thrombosis after primary PCI for AMI. The incidence of early thrombosis after primary angioplasty and stenting is decreased by abciximab use.
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Comparative Study
Warfarin and aspirin use and the predictors of major bleeding complications in atrial fibrillation (the Framingham Heart Study).
The Framingham Heart Study records of participants with atrial fibrillation (AF) during 1980 and 1994 were retrospectively reviewed to determine the prevalence of warfarin and aspirin use in AF. Anticoagulant use increased significantly in the 393 men and women (mean ages 72.5 and 79.0 years, respectively) who developed AF over the observation period: aspirin use increased from 14% to 39% in men and from 19% to 33% in women, and warfarin use increased from 10% to 39% in men and from 17% to 38% in women. ⋯ A total of 65 participants (17%) had major bleeding complications
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Comparative Study
A change in serum myoglobin to detect acute myocardial infarction in patients with normal troponin I levels.
We sought to determine the sensitivity of a change in myoglobin for acute myocardial infarction (AMI) in patients who had normal levels of troponin I at presentation. Myoglobin increases as soon as 1 to 2 hours after symptom onset in AMI. The change in myoglobin may help identify AMI in patients with normal cardiac levels of troponin I on admission. ⋯ In the absence of an increased level of cardiac troponin I or myoglobin at presentation in the emergency department, a change >or=20 ng/ml of myoglobin at 90 minutes produced 83.3% sensitivity, 88.6% specificity, and 99.5% negative predictive value for AMI. The combined sensitivity of levels of cardiac troponin I and myoglobin and a change >or=20 ng/ml of myoglobin over 90 minutes was 97.3%. In emergency department patients with normal cardiac levels of troponin I at presentation, a change in myoglobin provides a highly accurate diagnosis of AMI within 90 minutes.
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Comparative Study
Cardiac troponin T elevation after coronary artery bypass grafting is associated with increased one-year mortality.
The results of the present study extend the value of assessing troponin T for the prediction of mortality rate 1 year after coronary artery bypass grafting; this study supports previous work that demonstrated the value of postoperative assessment of troponin T for the prediction of in-hospital adverse outcome after coronary artery bypass grafting.
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Comparative Study
Acute angiographic analysis of non-ST-segment elevation acute myocardial infarction.
Most revascularization studies on acute myocardial infarction have included patients who have ST-segment elevation or new-onset left bundle branch block. However, the characteristics of patients who have non-ST-segment elevation acute myocardial infarction and who have undergone angiographic analysis of their infarct-related arteries have not been adequately described. This study suggests that these patients are likely to have had coronary bypass surgery (odds ratio 4.58, 95% confidence interval 1.83 to 11.5, p = 0.0012) and that circumflex artery occlusions are more likely to present as non-ST-segment elevation than as acute myocardial infarction with ST-segment elevation and/or left bundle branch block (odds ratio 2.91, 95% confidence interval 1.62 to 5.22, p = 0.0003).