American heart journal
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American heart journal · Feb 1999
Randomized Controlled Trial Multicenter Study Clinical TrialSHould we emergently revascularize Occluded Coronaries for cardiogenic shocK: an international randomized trial of emergency PTCA/CABG-trial design. The SHOCK Trial Study Group.
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American heart journal · Feb 1999
Randomized Controlled Trial Multicenter Study Clinical TrialIs all unstable angina the same? insights from the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT-I). The CAVEAT-Investigators.
Certain characteristics of unstable angina have been associated with worse clinical outcomes after percutaneous revascularization procedures. ⋯ Patients with unstable angina have more complications of percutaneous revascularization than patients without unstable angina, but event rates vary by anginal subgroup. The clinical presentation may help to identify unstable angina patients at particularly high risk for adverse outcomes.
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American heart journal · Feb 1999
Implementation of serum cardiac troponin I as marker for detection of acute myocardial infarction.
The goal of this prospective study was to assess whether cardiac troponin I (cTnI) could replace creatine kinase (CK)-MB mass as the serum biochemical marker for detection of acute myocardial infarction (AMI). ⋯ These findings have strongly supported our clinical implementation of cTnI, replacing CK-MB mass as the preferred marker for detection of AMI.
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American heart journal · Jan 1999
ReviewCardiopulmonary resuscitation: historical perspective to recent investigations.
There are at least 300,000 cardiac arrests annually in the United States. Cardiopulmonary resuscitation (CPR) effectively restores hemodynamic stability, return of spontaneous circulation (ROSC), in 40% to 60% of arrests. Prolonged survival is significantly lower because of underlying illness and the postresuscitation syndrome, specifically central nervous system injury and left ventricular stunning after resuscitation. ⋯ Active compression-decompression and interposed abdominal compressions improved ROSC in prospective randomized trials; abdominal compressions have also been shown to increase survival to hospital discharge. Despite 30 years of research, CPR is now performed much as it was initially. Further research into the mechanisms of cardiac arrest, development of predictive models, and improved means to improve cardiac output and survival are needed.
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American heart journal · Jan 1999
Trends in the use of pharmacotherapies for acute myocardial infarction among physicians who design and/or implement randomized trials versus physicians in routine clinical practice: the MILIS-TIMI experience. Multicenter Investigation on Limitation of Infarct Size. Thrombolysis in Myocardial Infarction.
Although studies have documented that randomized, controlled trials (RCTs) have a measurable influence on clinical practice, investigators have uncovered important deficiencies in the application of RCT findings to the management of acute myocardial infarction (AMI). Little is known about the extent to which physicians who design and/or implement clinical trials differ from physicians in routine practice in their translation of the literature. ⋯ Physicians who design and/or implement RCTs translate the results of the medical literature more promptly and to a greater extent than physicians in routine clinical practice. Differences between different physician classes need to be studied further amid efforts to reconfigure health care delivery that currently favor more dominant roles for primary care physicians.