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Results 601 - 650 of 725
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Mueller H S - - 1990
Coronary thrombolysis revolutionized the treatment of acute myocardial infarction. Most of the experience was obtained with intravenous use of streptokinase and tissue-type plasminogen activator, the latter being superior to streptokinase in regard to coronary recanalization. Numerous other promising thrombolytic agents are being investigated. Both streptokinase and tissue-type plasminogen activator decreased ...
Van Rossum A C - - 1990
The use of the paramagnetic contrast agent gadolinium-diethylene-triamine pentaacetic acid (DTPA) was evaluated in magnetic resonance imaging (MRI) of 18 patients with an acute myocardial infarction after thrombolysis. The patency of the infarct-related vessel was assessed by coronary angiography. At 58 +/- 9 hours after infarction MRI was performed before ...
Chesebro J H - - 1990
Survival of patients with acute transmural infarction is largely related to the size of the myocardial infarction. The goal of thrombolytic therapy in acute myocardial infarction is maximal salvage of myocardium by reestablishment of flow in the occluded infarct-related artery and the establishment and maintenance of a patent infarct-related artery. ...
Mickelson J K - - 1990
Coronary artery rethrombosis can complicate initially effective thrombolytic therapy. Platelets interacting with injured vascular endothelium in a region along the coronary artery with reduced luminal cross-sectional area contribute to rethrombosis. The purpose of this study was to investigate the potential of the F(ab')2 fragment of the murine monoclonal antibody 7E3 ...
Bell D - - 1990
Activated neutrophils releasing proteolytic enzymes and oxygen free radicals have been implicated in extending myocardial injury after myocardial infarction. Neutrophil elastase was used as a marker of neutrophil activation and the non-peroxide diene conjugate of linoleic acid was used as an indicator of free radical activity in 32 patients after ...
Tiefenbrunn A J - - 1990
Intracoronary tissue-type plasminogen activator (t-PA) was employed successfully before, after, or in place of coronary artery angioplasty in four patients referred for emergency cardiac catheterization during evolving myocardial infarction. The potential roles of intracoronary thrombolysis, dose considerations for intracoronary t-PA, factors influencing the choice of plasminogen activator, and safety issues ...
Di Pasquale P - - 1990
Studies on experimental animals indicate that ACE-inhibition might play an important role in coronary flow regulation and reperfusion damage limitation by alleviating non-irreversible myocardial damage and reducing Hyperkinetic Ventricular Arrhythmias (HVA) caused by reperfusion. This suggests the usefulness of captopril, an ACE-inhibitor containing the -SH group, in combination with systemic ...
Pitt B - - 1990
The results of several major trials of i.v. thrombolysis in patients with acute myocardial infarction have demonstrated the efficacy of the treatment in reducing mortality. Streptokinase and rt-PA have been shown to be effective (APSAC = anisoylated plasminogen streptokinase activator complex; GISSI = Gruppo Italiano per lo Studio della Streptochinasi ...
Höfling B - - 1990
The classical approach to the treatment of acute myocardial infarction (MI) has been one of stabilization and complication management. In an effort to optimize treatment, the initiation of the cardiac care unit and the use of antiarrhythmic therapy have succeeded in lowering the mortality rate substantially. More modern concepts are ...
Roberts R - - 1989
Randomized, placebo-controlled trials have documented that both streptokinase and rt-PA given early are associated with limitation of infarct size, improved ventricular function, and reduced mortality. Other concerns, however, documented experimentally include myocardial hemorrhage, the "no-reflow" phenomenon, myocardial "stunning," reperfusion-induced injury, and clinically, rethrombosis that occurs at a rate of 20% ...
Jang I K - - 1989
The effects of beta-adrenergic blockade, thrombolysis and their combination on infarct size and left ventricular function were investigated in a canine model of thrombotic occlusion of the left anterior descending coronary artery. Metoprolol was administered intravenously (0.5 mg/kg) over 10 min, starting 15 min after occlusion. Recombinant human tissue-type plasminogen ...
Stafford P J - - 1989
Seven of 475 consecutive patients treated with thrombolysis for acute myocardial infarction had severe embolic complications that were believed to be caused by disintegration of pre-existing clot. Three patients had symptoms that persisted for many weeks, and five died. Any potential site of pre-existing blood clot within the vascular system, ...
Neuhaus K L - - 1989
To improve further the patency rate of infarct-related coronary arteries, the following accelerated dosage regimen of recombinant tissue-type plasminogen activator (rt-PA) was administered to 80 patients with acute myocardial infarction of less than or equal to 6 h duration: 15 mg intravenous bolus, 50 mg infusion over 30 min and ...
Chaitman B R - - 1989
The impact of age on hospital mortality, incidence of major hemorrhagic events and transfusion requirements was examined in 756 patients with acute myocardial infarction enrolled in the Thrombolysis in Myocardial Infarction (TIMI) Phase I, open label studies and the TIMI Phase II pilot study. The mortality rate significantly increased with ...
Kurata C - - 1989
A 67-year-old man developed an acute myocardial infarction shortly after normal exercise testing. His clinical history and findings from emergency coronary arteriography suggested that coronary artery spasm followed by intraluminal thrombosis might have been responsible for the myocardial infarction. Although intracoronary thrombolysis two hours after the onset of chest pain ...
Ellis S G - - 1989
Ischemic events after successful thrombolysis have been reported to occur in 18-32% of patients treated for acute myocardial infarction with thrombolytic therapy, and previous studies in which patients received streptokinase suggest that risk of early recurrent ischemia is closely related to the presence of a high-grade residual stenosis. If these ...
Hurley D V - - 1989
The precise timing of intravenous thrombolysis and coronary angioplasty continues to be evaluated for patients who have coronary thrombosis and unstable angina or postinfarction angina. Coronary angioplasty is effective for these patients but is associated with thromboembolic coronary occlusion in 24% to 29% of cases. After adjunctive intravenous thrombolysis and ...
Komamura K - - 1989
Previous experimental studies have clarified the effectiveness of intermittent coronary sinus occlusion or ICSO. We evaluated the clinical feasibility, safety and effectiveness of ICSO in the patients with acute myocardial infarction (AMI) who were treated with concomitant thrombolytic therapy. Implementation of ICSO was obtained in 76% of the eligible patients. ...
Grines C L - - 1989
Although impairment of left ventricular function in acute myocardial infarction is closely related to extent of necrosis, function in the noninfarct zone also contributes to global performance and thus may be of prognostic importance. We evaluated left ventricular regional wall motion by the centerline chord method in 332 patients treated ...
Chamberlain D A - - 1989
Data available experimentally and from major trials suggest that the beneficial effects of thrombolysis depend on more than simple reperfusion. New knowledge regarding the dynamic nature of clot formation and clot lysis enables us to understand more of the processes involved in thrombolysis. The breakdown of systemic fibrinogen may be ...
Onodera T - - 1989
The postmortem histology and the results of cineangiography after selective intracoronary thrombolysis in vessels that were recanalized and in those that were not were compared in 21 patients who died within seven days (mean 2 days) of selective intracoronary thrombolysis. There was a persistent intraluminal thrombus in the infarct related ...
McNeill A J - - 1989
Within four hours of the onset of acute myocardial infarction 57 consecutive patients were randomised blindly to infusion of 150 mg recombinant tissue plasminogen activator (rt-PA) (group 1) over five hours or placebo (group 2) when they were first seen outside hospital or in the accident and emergency department. When ...
Loscalzo J - - 1989
Recognition that myocardial infarction is caused by coronary thrombosis has stimulated a search for a safe, rapidly acting, and effective thrombolytic regimen. Tissue plasminogen activator (t-PA) can provide relatively clot-selective thrombolysis, but one quarter of patients fail to achieve reperfusion, lysis speed is not optimal, and higher doses have been ...
Mueller H S - - 1989
Thrombolysis with pharmacologic agents is a valuable modality for treatment of acute myocardial infarction. The results of several clinical studies indicate that early recanalization can be elicited with intravenous agents and that it is associated with substantial reductions of infarct size, improvement of ventricular function, and reduction in mortality. The ...
Wall T C - - 1989
To determine the association of qualitative and quantitative measurements of the myocardial infarct-related coronary narrowing with subsequent recurrent ischemia/reocclusion after successful thrombolysis, 47 patients treated with high-dose (150 mg) tissue plasminogen activator over 6 to 8 hours were studied in the setting of acute myocardial infarction. No patient underwent emergent ...
Bergmann S R - - 1989
Potent pharmacological agents that rapidly induce coronary thrombolysis reduce morbidity and mortality from evolving myocardial infarction especially when administered early after the onset of ischemia. However, recanalization frequently unmasks residual, high-grade stenoses that can impair reflow, predispose to reocclusion, and limit salvage of myocardium. Coronary angioplasty performed immediately after recanalization ...
Ross A M - - 1989
This decade has witnessed the establishment of thrombolysis, the most widely available therapeutic intervention that specifically treats the direct cause of myocardial infarction and leads to biologically and clinically compelling patient outcome benefits. The next series of investigational tasks will refine issues such as patient and drug selection and optimal ...
Sternbach G - - 1989
The emergence of coronary artery thrombolysis and angioplasty have raised new questions about the transfer of patients with acute myocardial infarction (AMI). Since these modalities are generally limited in their availability, and since the success of thrombolysis is strongly time-dependent, the interfacility transfer of patients during AMI has become more ...
Messmer B J - - 1989
Successful thrombolysis for acute myocardial infarction reduces early mortality. For definite correction of the underlying arteriosclerotic lesion, invasive treatment is mandatory. Early bypass grafting has been performed in 70 patients with an ischemic interval of less than 4 hours before reperfusion by thrombolysis. Surgery was undertaken an average of 4.5 ...
Faxon D P - - 1988
Coronary reperfusion early after the onset of acute myocardial infarction can restore vessel patency, improve ventricular function and reduce short- and long-term mortality. A number of reperfusion methods have been used to achieve vessel patency in acute myocardial infarction, but each strategy varies considerably in its risk to the patient. ...
Topol E J - - 1988
In the first three phases of Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) multicenter trials, 708 patients received intravenous recombinant tissue-type plasminogen activator (rt-PA) and underwent detailed assessment of clinical, angiographic and ventriculographic outcomes. The cumulative experience and data base afford the opportunity to address several important questions regarding aggressive ...
Schofer J - - 1988
The accuracy with which intracoronary thallium and technetium pyrophosphate scintigraphy during intracoronary thrombolysis predicts myocardial salvage was studied in 58 patients with acute myocardial infarction by comparing the acute scintigraphic findings with subsequent left ventricular function. Scintigrams obtained before and immediately after thrombolysis were interpreted by three independent observers using ...
Ishikawa K - - 1988
Left ventriculograms were performed on 65 patients with acute myocardial infarction, once upon admission and again 3 months later. In 29 cases urokinase was injected intravenously and/or intracoronarily. The other 17 were treated without urokinase. In 8 out of 29 patients whose infarct-related coronary arteries remained completely occluded following urokinase ...
Kambara H - - 1988
Coronary recanalization rates and changes in the coagulation and fibrinolysis system were evaluated in a randomized fashion in patients with acute myocardial infarction after intracoronary administration of single-chain urokinase-type plasminogen activator (pro-urokinase: GE-0943) or urokinase. Three groups of patients were studied: group H (n = 50), 6,000 units pro-urokinase i.c.; ...
Tomoda H - - 1988
Salvage of the ischemic myocardium by coronary thrombolysis and mechanical recanalization (simulated angioplasty) was studied in a canine experimental model of acute myocardial infarction induced by coronary occlusive thrombus at the left anterior descending coronary artery. Forty-four open-chest dogs divided into three groups were studied. Group I (n = 15, ...
van der Wall E E - - 1988
The effects of recanalization by early intracoronary streptokinase in acute myocardial infarction on myocardial perfusion were studied in a subset of 236 out of 533 patients enrolled in a prospective multicentre trial, randomly allocated to either conventional treatment or to thrombolysis. Maximal symptom-limited thallium-201 stress testing was performed nine to ...
Hattori R - - 1988
Acute reocclusion of the recanalized infarcted vessel was observed during thrombolytic therapy in 28 or 138 patients, and during angioplasty following thrombolysis in 5 of 70 patients. The occluded vessel reopened again in 20 of 28 patients by additional administration in nitroglycerin and urokinase and in 3 of 5 patients ...
Barzilai B - - 1988
We have previously shown that the intrinsic properties of myocardium can be characterized quantitatively by the assessment of ultrasonic integrated backscatter. In this study we utilized a novel, real-time, two-dimensional system capable of quantitative integrated backscatter imaging to determine whether zones of remote myocardial infarction in dogs could be delineated ...
Topol E J - - 1988
To evaluate the feasibility and cost savings of hospital discharge three days after acute myocardial infarction, we screened 507 consecutive patients prospectively for clinical complications and exercise-test performance. Of 179 patients whose condition was classified as uncomplicated (no angina, heart failure, or arrhythmia 72 hours after admission), 126 underwent early ...
Vermeer F - - 1988
Immediate PTCA following thrombolysis with streptokinase was performed in 46 out of 533 patients enrolled in a multicentre randomized trial of early reperfusion in patients with acute myocardial infarction. Additional effects of PTCA in patients with a residual diameter stenosis in the infarct-related coronary artery of 70% or more after ...
Valente M - - 1988
Ninety-two patients with acute myocardial infarction, treated with intracoronary thrombolysis within 3 h from the onset of ischemic symptoms, were studied with coronary arteriography and left ventriculography. These examinations were repeated after 2 to 4 weeks to assess the importance of duration of ischemia on recovery of regional and global ...
Chambers J - - 1988
A 65-year-old female, presenting 32 weeks after mitral valve replacement with malaise and weight loss, was found to have a massive left atrial thrombus. She was treated successfully with streptokinase 1,000,000 units followed by anticoagulation with heparin then warfarin. The Doppler ultrasound recordings of left ventricular inflow were biphasic on ...
Suryapranata H - - 1988
Between September 1981 and May 1986, coronary angioplasty immediately after intracoronary thrombolysis was attempted in 115 patients with acute myocardial infarction. The present study describes our experience with this combined procedure. Primary success was achieved in 102 patients (89%). Before discharge, 79 of these patients agreed to be restudied angiographically. ...
- - 1988
144 patients presenting within 4 h of onset of myocardial infarction were randomised to receive either 100 mg of single-strand recombinant tissue plasminogen activator (rTPA) in 3 h (n = 73) or placebo infused at the same rate (n = 71). All patients were given heparin 5000 units before the ...
Taylor S H - - 1988
Despite recent advances, problems in the treatment of acute myocardial infarction still remain. In the earliest stages of the syndrome thrombolysis holds substantial if not absolute promise but many patients present too late for it to be effective. In these latter individuals and those in whom thrombolysis was not successful, ...
Hackett D - - 1988
We have investigated the coronary vasodilator responses to nitrates in the early stages of acute myocardial infarction before, during and after the administration of thrombolytic therapy. Before thrombolysis, intracoronary doses (2-4 mg) of isosorbide dinitrate failed to induce recanalisation of the totally occluded infarct related artery. Episodes of coronary reopening ...
Grines C L - - 1988
To determine the risk of arterial reocclusion or recurrent ischemia after acute intervention in myocardial infarction, we analyzed the results of coronary arteriography performed acutely and at 1 week in 50 consecutive patients who received acute intervention. Successful recanalization of the infarct vessel was achieved in 46 (92%) patients after ...
Lotan C - - 1988
Temporal changes in residual stenosis in the infarct-related coronary artery and ventricular function were studied in 30 consecutive patients with an acute myocardial infarction who received rapid, high dose intravenous infusions of streptokinase within 4 h of pain onset. Patients were studied 6 days and 3.9 +/- 1.3 months after ...
Hugenholtz P G - - 1988
In the present era of thrombolysis, congestive heart failure secondary to (sub)acute coronary artery obstruction can be reduced to a considerable extent or even avoided altogether. Evidence from several recent trials in humans, aimed at restoring perfusion of the jeopardized myocardium-and thus preserving normal ventricular function-is presented. It is clear ...
Sobel B E - - 1987
Because of its enhanced activation of plasminogen in association with fibrin compared with free plasminogen, tissue-type plasminogen activator (t-PA) evoked excitement as a potentially useful pharmacologic activator of the fibrinolytic system. Initial studies in experimental animals and patients demonstrated that it induced coronary thrombolysis rapidly and without concomitant, marked fibrinogenolysis ...
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