Search Results
Results 451 - 500 of 1096
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Hood S - - 1996
OBJECTIVES: (a) To assess the practice of junior doctors who administer thrombolytic therapy in acute myocardial infarction. (b) To assess whether wider implementation of current guidelines is indicated. DESIGN: Postal questionnaire survey. Each questionnaire was followed by a reminder. SETTING: Teaching and district general hospitals in Central and Southern Scotland. ...
Szto G Y - - 1996
A six-month prospective study was performed to assess the efficacy of delivering thrombolytic therapy to patients with acute myocardial infarction and admitted to the coronary care unit. Patient characteristics, time from chest pain onset to presentation to emergency department, from presentation to thrombolytic therapy, transfer from emergency department to coronary ...
Keller N M - - 1996
The elderly represent an increasingly important and challenging subset of the population of patients with ischemic heart disease. They are more likely to have comorbid conditions, atypical presentations, and unfavorable outcomes than their younger counterparts. Some of these findings are undoubtedly related to the structural and functional changes in the ...
Selig M B - - 1996
Early identification and treatment, including administration of intravenous thrombolytics, coronary angioplasty, and adjunctive therapies, has been shown to benefit patients who present with acute myocardial infarction. However, only a small percentage of these patients receive such therapies because of late presentation, associated risks, and controversies around certain myocardial infarct subsets. ...
Juergens C P - - 1996
OBJECTIVES: We examined the utility of the 32-point QRS score from the 12-lead electrocardiogram (ECG) for measurement of the ischemic risk region and infarct size in patients receiving thrombolytic therapy. BACKGROUND: The QRS score offers a means of evaluating the therapeutic benefit of thrombolytic therapy by comparing final infarct size ...
Candelise L - - 1996
Thrombolysis is proposed for the acute treatment of cerebral infarction as it is able to recanalize occluded arteries and thus potentially restore normal perfusion of the cerebral parenchyma, but the results concerning the efficacy of this treatment are still inconclusive. However, it has been fully demonstrated that thrombolytic treatment, leads ...
Boissel J P - - 1996
Reperfusion-induced ventricular fibrillation has been demonstrated in animal models of myocardial ischaemia, but no evidence exists for this in humans. The European Myocardial Infarction Project compared the efficacy and safety of pre-hospital thrombolytic therapy with that of hospital therapy. The objective of this study was to investigate the occurrence of ...
- - 1996
OBJECTIVES: This 6-month follow-up analysis sought to assess whether the early reduction of mortality obtained with a 6-week treatment course of lisinopril or glyceryl trinitrate, or both, in unselected patients with acute myocardial infarction outlasts therapy and is still present after 6 months. The primary outcome of the 6-month follow-up ...
Huber K - - 1996
Despite major advances made over the last decade, mortality following acute myocardial infarction (MI) is still high even for patients treated with the "front-loaded" recombinant tissue-type plasminogen activator (rt-PA) regimen: 30-day mortality is 6.3%, and it is associated with fatal cerebral hemorrhage in 1.5%. Further improvement of short- and long-term ...
Gulba D C - - 1996
Thrombolysis today has become a routine option not only in the treatment of acute myocardial infarction but also in many other manifestations of thromboembolic disease. Until one decade ago, only two plasminogen activators, streptokinase and urokinase, were available for clinical use. They were characterized by limited thrombolytic potencies and major ...
Metz B K - - 1996
For the treatment of acute myocardial infarction, heparin has been a topic of continuing debate for the past four decades. After review of the available data, the American College of Cardiology/American Heart Association Guidelines for the Early Management of Patients with Acute Myocardial Infarction, published in 1990, recommended intravenous heparin ...
Chandler W - - 1996
Fibrinolytic activity in blood is regulated by a dynamic process that includes control of production, secretion, inhibition, and clearance of fibrinolytic proteins. The concentration of active tissue plasminogen activator (tPA) in the region of the thrombus controls the rate of fibrinolytic activation. We have developed a first-generation kinetic model that ...
Derad I - - 1996
Effects of therapy with urokinase (UK) and with recombinant tissue plasminogen activator (rtPA) were compared in patients with acute myocardial infarction (AMI). To achieve homogenous therapeutic conditions the comparison was restricted to patients having their first AMI and to cases of clinically successful thrombolytic therapy (defined by non-invasive criteria, such ...
Poeppelmeier J - - 1996
The aim of the study was to compare in a single trial, using identical methodology, the pharmacokinetic properties and the effect on the hemostatic system of saruplase (unglycosylated scu-PA) and urokinase (glycosylated tcu-PA). Twenty-four patients with an acute myocardial infarction were either treated with saruplase (n = 12; 20 mg ...
Bode C - - 1996
Large efforts have been undertaken to develop more effective and safer thrombolytic agents than those currently used in clinical practice. In addition, the value of adjunctive agents influencing thrombotic and thrombolytic processes could be shown and newer agents are under active investigation. This review focuses on theoretical and practical aspects ...
Boersma H - - 1996
Currently several modes of reperfusion therapy for acute myocardial infarction are available. Streptokinase, accelerated alteplase and direct angioplasty are the most frequently used. These options are increasingly effective, but are also increasingly complex and costly. Since, unfortunately, physicians are often restricted by budget limitations, choices must be made in clinical ...
Raitt M H - - 1996
BACKGROUND: Myocardial salvage is most likely to occur when thrombolytic therapy is administered within 4 to 6 hours of the onset of symptoms of myocardial infarction. The impact of delays within this early time period on final myocardial infarct size are unknown. The purpose of this study was to quantitate ...
Buth J - - 1996
Acute occlusion of the abdominal aorta is infrequently observed. The clinical presentation may vary from acute limb ischaemia, neurologic symptoms of the lower extremities, abdominal symptoms and acute hypertension. This clinical picture is caused by embolic occlusion or, more often, by acute thrombosis. Pre-existing atherosclerosis combined with a low flow ...
Huber K - - 1996
Despite the major advances made over the last decade, mortality following acute MI is still high for patients even if treated with the so far most effective "front-loaded" rt-PA regimen: 30-day-mortality is 6.3% and is associated with fatal cerebral haemorrhage in 1.5%. Further improvement of short- and long-term prognosis can ...
Lauer J E - - 1995
Thrombolytic therapy salvages ischemic myocardium by rapidly reestablishing coronary artery patency in acute myocardial infarction. One of its major limitations is the complication of hemorrhage. A retrospective study of myocardial infarction patients who received thrombolytic therapy was performed to determine risk factors associated with a hemorrhagic event. Three hundred fifty ...
Barbagelata A - - 1995
Early postinfarction angina implies an unfavorable prognosis. Most published information on this outcome represents data collected in the prethrombolytic era, in which definitions and populations differed considerably. Our purpose was to evaluate the incidence and importance of recurrent ischemia after administration of thrombolytic therapy. We studied patients enrolled in the ...
Arnold A E - - 1995
Thrombolytic therapy is a major step forward in the treatment of acute myocardial infarction and results in substantial reduction of mortality. However, in individual patients the benefits and bleeding risk are difficult to estimate, especially when benefit seems small or outweighed by the risk of intracranial bleeding. For this and ...
Barradell L B - - 1995
Alteplase (recombinant tissue plasminogen activator; rt-PA) is a thrombolytic agent that when given in an accelerated regimen with intravenous heparin has survival advantages compared with streptokinase in the treatment of acute myocardial infarction, as shown by the results of the Global Utilisation of Streptokinase and Tissue Plasminogen Activator for Occluded ...
Cutler D - - 1995
The therapeutic efficacy of thrombolytic therapy for the treatment of acute myocardial infarction was first demonstrated convincingly in 1985 by the GISSI investigators. In the ensuing 10 years, continued clinical investigation has focused on improving the safety and efficacy of thrombolytic therapy. In addition to the use of adjunctive agents ...
Mark D B - - 1995
The era of coronary reperfusion in acute coronary care was made possible by the recognition that acute myocardial infarction is usually due to a ruptured atherosclerotic plaque with associated thrombosis. If the infarct artery becomes occluded, a typical electrocardiographic picture is produced and a wave-front of myocardial necrosis ensues. Reperfusion ...
Vanderschueren S - - 1995
BACKGROUND: Recombinant staphylokinase (STAR) induces fibrin-specific coronary artery recanalization in patients with evolving myocardial infarction. The present pilot study evaluates its thrombolytic efficacy, safety, fibrin specificity, and immunogenicity in patients with peripheral arterial occlusive disease. METHODS AND RESULTS: Thirty patients (37 to 86 years of age) with angiographically documented thromboembolic ...
Ogawa H - - 1995
Coronary recanalization rate and infarct size were compared between 2 different methods of intravenously administering recombinant tissue-type plasminogen activator (rt-PA) 41.4 mg; 1) an initial bolus dose of 30% followed by infusion of the remainder over 60 min (30% group), and an initial bolus dose of 10% followed by infusion ...
Quinn T - - 1995
The publication of large randomised trials such as ISIS 2 (1988) and AIMS (1990), provided striking evidence as to the effectiveness of thrombolytic therapy in reducing early mortality and morbidity in patients suffering acute myocardial infarction. This article will provide an overview of the use of thrombolytic agents in modern ...
Kellett J - - 1995
PURPOSE: A computerized decision analysis, based on the results of published clinical trials, assessed the risks, benefits, and costs of different thrombolytic regimens for suspected myocardial infarction (MI) throughout the likely range of clinical circumstances. DATA SOURCE: Medline search and articles' bibliographies. STUDY SELECTION: All studies reporting efficacy and side ...
Gott J P - - 1995
Most clinicians have become convinced of the fundamental role of an early reperfusion strategy in the improved outcome for patients suffering acute myocardial infarction. An increasing body of work suggests that the surgeon has the best opportunity for control of the conditions of acute reperfusion, attenuation of secondary injury, and ...
Tsevat J - - 1995
OBJECTIVES: This study sought to assess the cost-effectiveness of captopril therapy for survivors of myocardial infarction. BACKGROUND: The recent randomized, controlled Survival and Ventricular Enlargement (SAVE) trial showed that captopril therapy improves survival in survivors of myocardial infarction with an ejection fraction < or = 40%. The present ancillary study ...
Maynard C - - 1995
Very early administration of thrombolytic therapy for acute myocardial infarction (AMI) has significantly reduced mortality in eligible patients. The purpose of this study was to evaluate factors which influenced the time from symptom onset to hospital presentation and the time from hospital presentation to the onset of thrombolytic treatment in ...
Tousoulis D - - 1995
OBJECTIVE: To assess the frequency of early remodelling of coronary stenosis morphology after thrombolytic treatment in patients with acute myocardial infarction. DESIGN: Coronary angiograms were analysed by a computerised edge detection analysis system. Coronary stenosis severity was measured and morphology classified as smooth or complex. PATIENTS: Coronary arteriograms were obtained ...
Rogers W J - - 1995
Acute myocardial infarction, the leading cause of death in western society, has been the focus of more randomized clinical trial effort over the past decade than any other area of medicine. As a result of this worldwide effort, involving hundreds of thousands of patients with myocardial infarction, data have accumulated ...
Williams K - - 1995
Rapid diagnosis and treatment of myocardial infarction are essential for maximizing patient survival. Recent advances in early detection of creatine kinase myocardial band isoforms and other chemical markers, as well as increased use of echocardiography, magnetic resonance imaging, and nuclear imaging, have enhanced the diagnostic capabilities for providers caring for ...
Agnelli G - - 1995
Several trials enrolling thousands of patients have demonstrated the beneficial effect of thrombolytic therapy on survival in patients with acute myocardial infarction. Three large trials have compared the effect of different thrombolytic agents on mortality from myocardial infarction: GISSI-2/International trial, ISIS-3, and GUSTO. In this last trial, treatment with accelerated ...
Zarich S W - - 1995
OBJECTIVES: The present study was designed to test the efficacy and safety of a sequential combination of recombinant tissue-type plasminogen activator (rt-PA) and pro-urokinase in patients with acute myocardial infarction. BACKGROUND: Efforts continue to identify a thrombolytic regimen that induces rapid, complete and sustained coronary artery patency in acute myocardial ...
More R - - 1995
We reviewed the effectiveness of a strategy involving paramedic ambulances and community education to reduce the delay to thrombolytic therapy in patients admitted with acute myocardial infarction, by analysing delay times recorded during routine treatment. Rapid identification and treatment of patients with acute myocardial infarction who were eligible for thrombolysis ...
Anderson H V - - 1995
The role of coronary angiography in acute myocardial infarction is multifaceted. In the acute situation--for example, for primary angioplasty, suspected thrombolytic failure, or reocclusion--the goal of the angiographer should be therapeutic: to provide hemodynamic support, relieve ischemia, and interrupt the infarction process. In the nonacute or elective setting after infarction, ...
Rozenman Y - - 1995
Myocardial damage in acute myocardial infarction is a time-dependent process. We examined the influence of very early thrombolytic therapy, comparing prehospital to hospital administration, in a consecutive group of patients with myocardial infarction on mortality, complications and the preservation of left ventricular function. Seven hundred sixty patients received early thrombolytic ...
- - 1995
BACKGROUND: The delay between onset of symptoms and coronary care unit admission is decisive in the outcome of patients with acute myocardial infarction. OBJECTIVE: To evaluate the influence of the factors that affect the delay in acute myocardial infarction treatment. METHODS: Multicenter case-control study conducted by 118 coronary care units ...
Marder V J - - 1995
Thrombolytic therapy provides clinical benefit in patients with vascular occlusions, depending upon the organ or limb that is threatened. The impact of therapeutic intervention varies from the quiet alteration of the course of deep vein thrombosis, for which non-life threatening post-phlebitic syndrome can be largely avoided, to the sometimes striking ...
Collen D - - 1995
The fibrinolytic system comprises an inactive proenzyme, plasminogen, that is converted by plasminogen activators to the active enzyme, plasmin, that degrades fibrin. Two physiological plasminogen activators have been identified: tissue-type plasminogen activator (t-PA) and urokinase-type plasminogen activator (u-PA). Plasminogen activation for clot lysis is regulated by specific molecular interactions between ...
Lijnen H R - - 1995
Fibrinolytic (thrombolytic) agents activate the fibrinolytic system by conversion of the inactive proenzyme, plasminogen into the active enzyme plasmin, that degrades fibrin. Agents available for clinical use are: the physiologic tissue-type plasminogen activator (t-PA) and urokinase-type plasminogen activator (u-PA)--either in a single chain (scu-PA, prourokinase) or a two-chain (tcu-PA, urokinase) ...
Bhatnagar S K - - 1995
Ninety one consecutive survivors of a first acute myocardial infarction (MI) were studied prior to hospital discharge, in order to observe the relationship of signal-averaged electrocardiography (SAECG) to thrombolytic therapy, site of infarction and left ventricular function. Sixty six patients received thrombolytic agents and the remaining had conventional therapy. The ...
Meehan T P - - 1995
OBJECTIVE: To evaluate the feasibility of linking claims-based pattern analysis with medical record review in the assessment of quality of hospital care among Medicare beneficiaries with acute myocardial infarction. DESIGN: An analysis of risk-adjusted mortality after hospital admission for acute myocardial infarction using the regression model from the Health Care ...
Tapson V F - - 1995
Massive PE is a devastating clinical entity often undiscovered until autopsy. Acute right ventricular failure may progress to death within minutes to hours after the embolic event and prompt diagnostic and therapeutic intervention are imperative. The diagnosis heavily relies on clinical suspicion together with ventilation-perfusion scanning. Echocardiography may have a ...
Goldhaber S Z - - 1995
Thrombolytic therapy for venous thromboembolism is returning, especially for the management of acute pulmonary embolism patients who present with either hypotension or with right ventricular dysfunction despite an initially normal blood pressure and heart rate. Clinicians have learned to use thrombolysis to improve efficacy, minimize bleeding complications, and achieve savings ...
Collen D - - 1995
Despite their widespread use in patients with acute myocardial infarction, all currently available thrombolytic agents suffer from a number of significant limitations, including resistance to reperfusion, the occurrence of acute coronary reocclusion, and bleeding complications. Several lines of research towards improvement of thrombolytic therapy are being explored, including strategies to ...
Smith S M - - 1995
Acute myocardial infarction is a devastating cardiac clinical event, which is the result of progressive coronary arteriosclerosis. Coronary heart disease is a major health concern that accounts for a significant number of hospitalizations, health care expenditures, and deaths. Recent advancements in the nature and pathophysiology of progressive coronary disease and ...
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