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Results 351 - 400 of 1097
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Rutqvist L E - - 1998
PURPOSE: To assess the possible impact of the irradiation on the risk of acute myocardial infarction among breast cancer patients treated with conservative surgery and postoperative radiation therapy. METHODS AND MATERIALS: The incidence of and mortality from acute myocardial infarction was assessed in a group of 684 women with early-stage ...
Tiffany P A - - 1998
Thrombolytic therapy has been accepted in the treatment of acute myocardial infarction. Given historical recommendations that thrombolytic therapy is contraindicated in patients receiving CPR, its potential clinical benefit for facilitating conversion of rhythm in patients in refractory cardiac arrest has not been investigated. We present three case reports in which ...
Straznicky Ivan T. - - 1998
The incidence of myocardial infarction, and the subsequent mortality and morbidity increases markedly with age. Randomized placebo-contolled trials of fibrinolytic therapy have lacked adequate statistical power due to the relatively small numbers of older patients enrolled, but nevertheless have strongly suggested a mortality benefit in the older age group. Despite ...
el Gaylani N - - 1998
AIMS: To investigate the current use of thrombolytic therapy in the management of patients with acute myocardial infarction and to determine the potential for an increased use of thrombolysis or percutaneous transluminal coronary angioplasty (PTCA). METHODS AND RESULTS: All hospitalised cases of acute myocardial infarction were identified in three health ...
Reddy D S - - 1998
Arterial thrombosis is the underlying cause of a wide variety of cardiovascular diseases such as myocardial infarction, stroke and pulmonary thromboembolism. All the currently used thrombolytic agents are plasminogen activators, which are very efficient in restoring the blood flow. The fibrinolytic system comprises an inactive proenzyme plasminogen, that is converted ...
Serebruany VL - - 1998
Thrombolytic therapy has become a standard treatment for selected patients with acute myocardial infarction (MI). Various thrombolytic agents have been shown to decrease mortality. However, current thrombolytic agents still suffer significant shortcomings, such as a low optimal reperfusion rate delayed reperfusion. and incomplete myocardial perfusion. Furthermore, cyclic flow variations and ...
Bode C - - 1997
Thrombolysis has become an accepted form of therapy for acute myocardial infarction. As demonstrated in the Global Utilization of Streptokinase and t-PA for Occluded Arteries trial, early, complete and sustained patency of the infarct-related coronary artery is correlated with reduced mortality. However, current thrombolytic regimens are able to achieve such ...
Califf R M - - 1997
The GUSTO trials have provided continuing insight into the complexities of a simple fundamental relationship: early and sustained coronary perfusion in patients with acute myocardial infarction leads to lower mortality and morbidity. To a large extent, the GUSTO trials have attempted to develop approaches to therapy that will ensure the ...
Hampton J R - - 1997
Very large clinical trials have become the norm in the evaluation of thrombolytic agents, and these 'megatrials' are administratively complex and expensive. It remains to be seen whether new thrombolytics will lead to further large reductions in fatality from an acute myocardial infarction, but new agents may well have advantages ...
Lopez L M - - 1997
The open-artery hypothesis as supported by thrombolytic study results is discussed. The open-artery hypothesis states that survival after acute myocardial infarction (AMI) is maximized by achieving early and sustained patency of the infarct-related artery. However, two large multicenter trials did not detect any difference in mortality between patients given alteplase ...
Stringer K A - - 1997
The use of outcome markers other than mortality reduction alone for evaluating thrombolytic agents in patients with acute myocardial infarction (AMI) is discussed. Mortality has been a primary endpoint in clinical trials evaluating thrombolytic agents for treatment of AMI. However, differences in mortality rates among thrombolytics are 1% or less ...
Smalling R W - - 1997
The molecular pharmacology of plasminogen activators and its implications for thrombolytic therapy are discussed. The benefits of coronary thrombolysis were first demonstrated with intracoronary and i.v. streptokinase. Tissue plasminogen activator (t-PA) or recombinant t-PA (alteplase) proved to be superior to streptokinase with respect to speed of reperfusion and reperfusion efficacy. ...
Ryan T J - - 1997
The average time that elapses from a patient's first awareness of heart attack symptoms to start-up of specific reperfusion therapy is currently 4 hours. The National Heart Attack Alert Program wants to see this time reduced to 2 hours. Such dispatch would surely benefit patients, because when it comes to ...
Hu D - - 1997
OBJECTIVE: To investigate the clinical efficacy and safety of intravenous thrombolytic therapy of Urokinase Tech-Pool (UKTP) in acute myocardial infarction (AMI). METHODS: The data were collected from the 148 participating hospitals from November, 1994 to April, 1996. A total of 1,406 patients with AMI were analyzed to evaluate the clinical ...
Hennekens C - - 1997
Antithrombotic and thrombolytic therapies confer clear net benefits in the treatment of acute myocardial infarction (AMI). Antithrombotic therapy with aspirin yields conclusive reductions in vascular mortality as well as reinfarction and stroke and should be administered to all patients with suspected AMI. There is presently no clear evidence of net ...
Rapaport E - - 1997
Is there any good reason to give intravenous nitroglycerin during evolving acute myocardial infarction? How about a beta blocker? Should an ACE inhibitor be started routinely within the first 24 hours of infarction? When is aspirin useful for suspected acute myocardial infarction? Is it safe in patients with contraindications to ...
Edozien G Y - - 1997
We undertook criterion-based audit of the current practice of prescribing hormone replacement therapy for women with acute myocardial infarction; the audit included 181 consecutive women admitted to one hospital with this diagnosis in one calendar year. The set standard was that, barring any contraindication, all postmenopausal women with acute myocardial ...
van der Ent M - - 1997
Although several large studies indicate a beneficial effect of angiotensin-converting enzyme (ACE) inhibitors after myocardial infarction, the optimal timing of therapy in terms of safety and the effects on neurohormones during myocardial infarction are less well known. In order to investigate the effect of ramipril, administered within 24 h after ...
Arnold A E - - 1997
BACKGROUND: Thrombolytic therapy should only be used when expected benefits outweigh the risks. In order to obtain a precise estimation of prognosis, with and without thrombolytic therapy, we postulated that mortality reduction by thrombolytic therapy is a function of the area of myocardium at risk for necrosis. We developed a ...
Harvey R A - - 1997
Obtaining a prehospital 12-lead electrocardiogram (ECG) diagnostic of acute myocardial injury has been demonstrated to hasten the administration of thrombolytic agents in the emergency department. This case demonstrates that a prehospital electrocardiogram diagnostic of acute anterior wall infarction can become non-diagnostic following routine administration of oxygen, nitroglycerin, and morphine by ...
Stanek E J - - 1997
BACKGROUND: Despite extensive professional debate regarding the optimal thrombolytic therapy strategy in acute myocardial infarction (AMI), patient preferences have not been explored. METHODS: Preferences among patients with known or suspected coronary artery disease for treatment with tissue plasminogen activator (tPA) or streptokinase (SK) for AMI were determined using a questionnaire ...
Alexander J - - 1997
Based on results from a multitude of clinical trials of acute myocardial infarction, the beneficial role of a variety of pharmacologic agents, used in conjunction with thrombolytic therapy, has emerged. This is particularly true for aspirin, beta-blockers, heparin, and angiotensin-converting enzyme inhibitors. In addition, the dosage and timing of their ...
Whisenant B K - - 1997
Deaths from acute myocardial infarction have declined in recent years, thanks to the introduction of thrombolytic drugs and therapy with other types of medication that are beneficial when appropriately used. In this article, the authors review the mechanism of action of these agents and focus on recent clinical trials, indications ...
Rustige J - - 1997
AIMS: To describe patient characteristics, pre-hospital delay, treatment, complications and outcome in patients with acute myocardial infarction admitted to hospitals in Germany. METHODS AND RESULTS: The study was of prospective observational multicentre design. Those involved were consecutive patients with acute Q-wave myocardial infarction admitted within 96 h of onset of ...
Bett J H - - 1997
The best way to limit infarct size and improve survival in patients with early heart attacks is to restore as quickly as possible patency in the infarct-related artery and blood flow to the threatened myocardium. The value of thrombolytic therapy and aspirin has been shown in large clinical trials. A ...
de Bono D - - 1997
Alteplase (recombinant human tissue type plasminogen activator, rt-PA) was identified as a naturally occurring plasminogen activator in 1975, cloned from a human melanoma cell line in 1981, introduced into clinical trials in 1982, and received a product licence for the treatment of acute myocardial infarction in 1986. The present review ...
Aylward P - - 1997
Fibrinolytic therapy substantially reduces mortality from acute myocardial infarction. Patient selection is, however, important. The patient must present within 12 hours of the onset of ischaemic symptoms, have definite ECG changes of ST elevation or left bundle branch block and no contraindications. The major contraindications are those for risk of ...
Bode C - - 1997
Reteplase (r-PA) is a genetically engineered deletion mutant of wild-type tissue-type plasminogen activator. The structural differences lead to different functional properties, such as a prolonged half-life. The compound demonstrated good thrombolytic efficacy in in vitro as well as in animal studies. In angiographically controlled patency studies (GRECO, GRECO-2 RAPID-1, RAPID-2), ...
Alonzo A A - - 1997
In an era of highly time-dependent therapies for acute myocardial infarction-namely thrombolytic therapy and cardiopulmonary resuscitation-it is imperative that public education programs facilitate expeditious care-seeking. However, community intervention studies to reduce the interval of time-from the onset of an acute myocardial infarction to arrival at a hospital emergency department-have shown ...
Bratzler D W - - 1997
BACKGROUND AND OBJECTIVES: Acute myocardial infarction is the leading cause of death in the United States and a common cause for admission of Oklahoma Medicare beneficiaries. Based on guidelines for the management of acute myocardial infarction published by a joint committee of the American College of Cardiology and the American ...
Birkhead J S - - 1997
OBJECTIVE: To examine use of thrombolytic drugs for myocardial infarction and use of contraindications to treatment in the United Kingdom. DESIGN: Observational study, based on a continuing audit. SETTING: 39 hospitals in the United Kingdom. PATIENTS: 30,029 patients admitted between November 1992 and June 1995 with suspected myocardial infarction. RESULTS: ...
Krumholz H M - - 1997
OBJECTIVE: To determine the correlates of thrombolytic therapy use in a population-based sample of elderly patients hospitalized with acute myocardial infarction who were eligible for the therapy on presentation. DESIGN: Retrospective cohort study using data from medical charts and administrative files. SETTING: All acute care, nongovernmental hospitals in Connecticut. PATIENTS: ...
Berkowitz S D - - 1997
BACKGROUND: Although the benefit of thrombolytic therapy in reducing mortality in acute myocardial infarction is well established, the types of bleeding and risk factors for bleeding are less well described in large trials. METHODS AND RESULTS: We analyzed the baseline characteristics, outcomes, and incidence of bleeding by location, severity, and ...
Kawai C - - 1997
OBJECTIVES: This prospective, randomized, double-blind multicenter trial evaluated the efficacy and safety of a single bolus injection of the novel modified tissue-type plasminogen activator (t-PA) E6010 in the treatment of acute myocardial infarction compared with that of native t-PA. BACKGROUND: E6010 is a novel modified t-PA with a prolonged half-life ...
Loke Y K - - 1997
The objectives of this study were to evaluate the time delays between the onset of symptoms and admission to hospital and provision of thrombolytic therapy in patients with suspected acute myocardial infarction; and to examine the accuracy of the clinical diagnosis and the therapeutic decision on thrombolysis in these patients. ...
Castillo P A - - 1997
OBJECTIVE: To estimate the cost-effectiveness of thrombolytic therapy versus no thrombolytic therapy for patients following acute myocardial infarction, focusing on the impact of time to treatment on outcome. METHODS: A decision model was developed to assess the benefits, risks, and costs associated with thrombolytic therapy for treatment of acute myocardial ...
Hampton J R - - 1997
Thrombolytic trials in acute myocardial infarction have progressively increased in size, with the GUSTO study including over 40,000 patients. New thrombolytic drugs are unlikely to lead to further major reductions in fatality, and demonstrating small differences from existing compounds would require even larger trials to establish mortality benefits. New agents ...
Dracup K - - 1997
Physicians and other health care professionals play an important role in reducing the delay to treatment in patients who have an evolving acute myocardial infarction. A multidisciplinary working group has been convened by the National Heart Attack Alert Program (which is coordinated by the National Heart, Lung, and Blood Institute ...
Gordian M E - - 1997
This paper focuses on clinical quality improvement comparing the results of two studies done approximately one year apart on treatment of acute myocardial infarction in four rural hospitals. The purpose of both studies was to determine how often eligible, elderly Medicare patients with acute myocardial infarction received thrombolytic treatment and ...
- - 1997
OBJECTIVE: To investigate the long-term prognostic influence of patency of the infarct-related coronary artery. METHODS: One thousand two hundred and sixty seven cases of acute myocardial infarction with thrombolytic treatment between July 1991 and January 1995 in 36 collaborative hospitals were followed-up after discharge with a total follow-up rate of ...
Dayi H - - 1997
OBJECTIVE: To evaluate the efficacy of intravenous (i.v.) thrombolytic therapy on acute myocardial infarction (AMI) and to evaluate the sensitivity and specificity of clinical criteria in deciding reperfusion rate by using 90 minutes angiography after initiation of the i.v. urokinase (UK). METHODS: Coronary artery angiography (CAG) was performed in 124 ...
Aronson D - - 1997
PURPOSE: To review the pathogenic mechanism that lead to the poor prognosis of diabetic patients after myocardial infarction and to determine the efficacy of current interventions for myocardial infarction in these patients. DATA SOURCES: Search of the MEDLINE database from 1985 to 1995, using the keywords diabetes, myocardial infarction, and ...
Williams W L - - 1997
Acute myocardial infarction (AMI) evolves as a time-dependent wave front of ischemia when the abrupt rupture of an unstable fatty plaque initiates coronary thrombosis. The prospect of salvaging potentially viable myocardial tissue has led to the development of reperfusion strategies using thrombolytic agents. The efficacy of thrombolytic therapy is determined ...
Leizorovicz A - - 1997
OBJECTIVES: To compare the components of the time delay involved in pre-hospital and hospital thrombolytic therapy in patients presenting with suspected acute myocardial infarction. MATERIAL AND METHODS: From October 1988 to January 1992 a total of 198 mobile emergency units in 15 European countries and Canada randomized 5469 patients to ...
Jordaens L - - 1997
We studied influences on treatment and mortality in 787 patients with myocardial infarction in the setting of a prospective registry. Fifty % of patients received thrombolytics, 81% aspirin, and 46% beta-blockers. Decisions to give thrombolytics were influenced by gender and function. During hospital stay angioplasty was performed in 21%, and ...
- - 1997
OBJECTIVE: To evaluate the efficacy and safety of intravenous recombinant streptokinase (r-SK), produced in China, in the treatment of acute myocardial infarction (AMI). METHODS: One hundred and seventy-three patients with AMI admitted to seven hospitals from February to October 1995 were conformed to the inclusion and exclusion criteria of thrombolytic ...
White HD - - 1997
The direct thrombin inhibitor, hirudin, was tested in two trials. The TIMI 9B trial randomized patients receiving thrombolytic therapy for acute myocardial infarction to receive hirudin or heparin. The GUSTO IIB trial randomized patients with or without electrocardiographic ST-segment elevation (i.e. thrombolytic- and non-thrombolytic-eligible patients). In the combined trials at ...
Stringer K A - - 1997
Exogenous plasminogen activators (PAs), such as streptokinase (SK) and tissue plasminogen activator (tPA), have been shown to significantly improve the mortality of patients with acute myocardial infarction. However, reperfusion of the myocardium is associated with neutrophil activation and infiltration into the infarct region. Plasminogen activators influence neutrophil function in vitro, ...
Smith JJ - - 1997
Randomized trials of reperfusion therapy completed over the past decade have engendered the open-artery hypothesis. Collectively, patients with patent infarct-related arteries have fewer complications of their myocardial infarction, salutary effects on ventricular remodeling, and better survival. Thrombolytic therapy has been widely regarded as the most appropriate initial therapy for acute ...
Aversano T - - 1997
There are more than 600,000 acute myocardial infarctions (AMIs) in the United States each year, with direct medical costs exceeding $16 billion per year. Two treatment strategies are available for AMI today: medical therapy, including thrombolytic therapy, and primary angioplasty. Despite provocative preliminary data suggesting primary angioplasty results in lower ...
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