Journal ArticleJAMA Cardiol · September 1, 2024
IMPORTANCE: Pragmatic randomized clinical trials (RCTs) often use multiple data sources to examine clinical events, but the relative contribution of data sources to clinical end-point rates is understudied. OBJECTIVE: To assess the contribution of data sou ...
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Journal ArticleJ Am Heart Assoc · February 20, 2024
BACKGROUND: In patients with atherosclerotic cardiovascular disease, increasing age is concurrently associated with higher risks of ischemic and bleeding events. The objectives are to determine the impact of aspirin dose on clinical outcomes according to a ...
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Journal ArticleDiabetes Care · January 1, 2024
OBJECTIVE: Patients with diabetes mellitus (DM) and concomitant atherosclerotic cardiovascular disease (ASCVD) must be on the most effective dose of aspirin to mitigate risk of future adverse cardiovascular events. RESEARCH DESIGN AND METHODS: ADAPTABLE, a ...
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Journal ArticleJAMA Cardiol · November 1, 2023
IMPORTANCE: Clinicians recommend enteric-coated aspirin to decrease gastrointestinal bleeding in secondary prevention of coronary artery disease even though studies suggest platelet inhibition is decreased with enteric-coated vs uncoated aspirin formulatio ...
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Journal ArticleJ Am Heart Assoc · October 17, 2023
Background The ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness) was a large, pragmatic, randomized controlled trial that found no difference between high- versus low-dose aspirin for secondary prevention of ...
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Journal ArticleEur Heart J · June 1, 2023
Conventional randomized controlled trials (RCTs) can be expensive, time intensive, and complex to conduct. Trial recruitment, participation, and data collection can burden participants and research personnel. In the past two decades, there have been rapid ...
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Journal ArticleEur J Vasc Endovasc Surg · January 2023
OBJECTIVE: Endoleaks following thoracic endovascular aortic repair (TEVAR) can lead to the need for re-intervention and aortic rupture. Given the recent recall of a specific thoracic stent graft type due to concerns about type IIIb endoleak (T3bE), in whic ...
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Journal ArticleAm J Cardiol · September 1, 2022
Patients with acute coronary syndrome (ACS) are at risk for recurrent adverse events, and multiple reports suggest that this risk is increased in patients with concomitant diabetes mellitus (DM) and peripheral artery disease (PAD). The aim of this article ...
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Journal ArticleCirculation · August 30, 2022
BACKGROUND: Apolipoprotein B (apoB) provides an integrated measure of atherogenic risk. Whether apoB levels and apoB lowering hold incremental predictive information on residual risk after acute coronary syndrome beyond that provided by low-density lipopro ...
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Journal ArticleAm Heart J · July 2022
BACKGROUND: Little is known about the prevalence and prognostic impact of preexisting frailty on acute care and in-hospital outcomes in older adults in the setting of acute myocardial infarction (AMI). METHODS: Preexisting frailty was assessed at baseline ...
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Journal ArticleJ Am Coll Cardiol · May 3, 2022
The National Cardiovascular Data Registry is a group of registries maintained by the American College of Cardiology Foundation. These registries are used by a diverse constituency to improve the quality and outcomes of cardiovascular care, to assess the sa ...
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Journal ArticleJ Am Heart Assoc · February 15, 2022
Background Unlike patients with low ejection fraction after an acute coronary syndrome (ACS), little is known about the long-term incidence and influence of cardiovascular events before sudden death among stabilized patients after ACS. Methods and Results ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · December 2021
BACKGROUND: The ADAPTABLE trial (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness) is the first randomized trial conducted within the National Patient-Centered Clinical Research Network to use the electronic health rec ...
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Journal ArticleJ Urol · December 2021
PURPOSE: We examined changes in urological care delivery due to COVID-19 in the U.S. based on patient, practice, and local/regional demographic and pandemic response features. MATERIALS AND METHODS: We analyzed real-world data from the American Urological ...
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Journal ArticleCirculation · October 19, 2021
BACKGROUND: The relative cardiovascular safety of gonadotropin-releasing hormone (GnRH) antagonists compared with GnRH agonists in men with prostate cancer and known atherosclerotic cardiovascular disease remains controversial. METHODS: In this internation ...
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Journal ArticleTrials · August 16, 2021
BACKGROUND: Interest in the application of machine learning (ML) to the design, conduct, and analysis of clinical trials has grown, but the evidence base for such applications has not been surveyed. This manuscript reviews the proceedings of a multi-stakeh ...
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Journal ArticleJ Am Coll Cardiol · August 3, 2021
BACKGROUND: Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is unce ...
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Journal ArticleJAMA Netw Open · July 1, 2021
IMPORTANCE: Randomized clinical trials (RCTs) are critical in advancing patient care, yet conducting such large-scale trials requires tremendous resources and coordination. Clinical site start-up performance metrics can provide insight into opportunities f ...
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Journal ArticleHealth Qual Life Outcomes · June 13, 2021
OBJECTIVES: There has been limited success in achieving integration of patient-reported outcomes (PROs) in clinical trials. We describe how stakeholders envision a solution to this challenge. METHODS: Stakeholders from academia, industry, non-profits, insu ...
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Journal ArticleN Engl J Med · May 27, 2021
BACKGROUND: The appropriate dose of aspirin to lower the risk of death, myocardial infarction, and stroke and to minimize major bleeding in patients with established atherosclerotic cardiovascular disease is a subject of controversy. METHODS: Using an open ...
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Journal ArticleEur J Prev Cardiol · March 23, 2021
AIMS: Statins are pivotal to the secondary prevention of major adverse cardiovascular events, but some patients are statin-intolerant. We examined the effects of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor alirocumab on the risk of ...
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Journal ArticleCoron Artery Dis · March 1, 2021
BACKGROUND: The best timing for early invasive therapy in non-ST-segment elevation myocardial infarction (NSTEMI) patients remains controversial. We sought to determine the optimal timing of early catheterization in order to improve long-term outcomes in e ...
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Journal ArticleJ Am Heart Assoc · December 15, 2020
Background Coronary artery disease (CAD) is increasing among young adults. We aimed to describe the cardiovascular risk factors and long-term prognosis of premature CAD. Methods and Results Using the Duke Databank for Cardiovascular Disease, we evaluated 3 ...
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Journal ArticleAm J Med · December 2020
PURPOSE: We aimed to 1) describe characteristics of patients with heart failure with preserved ejection fraction (HFpEF) enrolled in RELAX stratified by normal or elevated baseline serum uric acid (sUA) level; 2) evaluate the association between sUA level ...
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Journal ArticleAm J Kidney Dis · December 2020
Occasional bursts of discovery and innovation have appeared during the otherwise stagnant past several decades of drug development in nephrology. Among other recent drug discoveries, the unexpected kidney benefits observed with sodium/glucose cotransporter ...
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Journal ArticleTher Innov Regul Sci · November 2020
In late 2018, the Food and Drug Administration (FDA) outlined a framework for evaluating the possible use of real-world evidence (RWE) to support regulatory decision-making. This framework was created to facilitate studies that would generate high-quality ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · September 2020
BACKGROUND: Longitudinal bleeding risk scores have been validated in patients treated with dual antiplatelet therapy (DAPT) following percutaneous coronary intervention. How these scores apply to the population of patients with acute coronary syndrome (ACS ...
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Journal ArticleEur J Prev Cardiol · July 27, 2020
AIMS: Statins are pivotal to the secondary prevention of major adverse cardiovascular events, but some patients are statin-intolerant. We examined the effects of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor alirocumab on the risk of ...
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Journal ArticleAm J Cardiol · July 15, 2020
Hyperuricemia and gout are common in patients with heart failure (HF) and are associated with poor outcomes. Data describing hyperuricemia and gout in patients with HF with preserved ejection fraction (HFpEF) are limited. We used data from the Duke Univers ...
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Journal ArticleCirculation · July 14, 2020
BACKGROUND: New randomized, controlled trials have become available on oral P2Y12 inhibitors in acute coronary syndrome. We aimed to evaluate current evidence comparing the efficacy and safety profile of prasugrel, ticagrelor, and clopidogrel in acute coro ...
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Journal ArticleJ Am Coll Cardiol · July 14, 2020
BACKGROUND: The long-term prognostic impact of post-discharge bleeding in the unique population of patients with acute coronary syndrome (ACS) treated without percutaneous coronary intervention (PCI) remains unexplored. OBJECTIVES: The aim of this study wa ...
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Journal ArticleEur Heart J · June 21, 2020
AIMS: Lowering low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular risk irrespective of age, but the evidence is less strong for older patients. METHODS AND RESULTS: This prespecified analysis from ODYSSEY OUTCOMES compared the effect of ali ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · June 2020
BACKGROUND: Many large-scale cardiovascular clinical trials are plagued with escalating costs and low enrollment. Implementing a computable phenotype, which is a set of executable algorithms, to identify a group of clinical characteristics derivable from e ...
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Journal ArticleCirc Heart Fail · June 2020
BACKGROUND: Obstructive hypertrophic cardiomyopathy (oHCM) is characterized by unexplained left ventricular (LV) hypertrophy associated with dynamic LV outflow tract obstruction. Current medical therapies are nonspecific and have limited efficacy in reliev ...
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Journal ArticleJ Invasive Cardiol · June 2020
OBJECTIVES: Limited studies of percutaneous coronary intervention (PCI) of the left internal mammary artery (LIMA) graft exist. We compared outcomes of different bypass grafts to the left anterior descending (LAD) coronary artery. METHODS: Participants ≥65 ...
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Journal ArticleCirculation · May 19, 2020
BACKGROUND: Patients with acute coronary syndrome are at risk for peripheral artery disease (PAD) events and venous thromboembolism (VTE). PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors reduce lipoprotein(a) and low-density lipoprotein ch ...
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Journal ArticleJ Am Coll Cardiol · May 12, 2020
BACKGROUND: Cholesterol reduction with proprotein convertase subtilisin-kexin type 9 inhibitors reduces ischemic events; however, the cost-effectiveness in statin-treated patients with recent acute coronary syndrome remains uncertain. OBJECTIVES: This stud ...
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Journal ArticleJAMA Cardiol · May 1, 2020
IMPORTANCE: Determining the right dosage of aspirin for the secondary prevention treatment of atherosclerotic cardiovascular disease (ASCVD) remains an unanswered and critical question. OBJECTIVE: To report the rationale and design for a randomized clinica ...
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Journal ArticleAm J Cardiol · April 15, 2020
Intraocular bleeding is a devastating clinical event due to its potentially blinding nature. It is not known if determine if dual antiplatelet therapy using aspirin and potent P2Y12 inhibitors increases this risk. We searched MEDLINE and ClinicalTrials.gov ...
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Journal ArticleSci Rep · April 10, 2020
Changes in platelet physiology are associated with simultaneous changes in microRNA concentrations, suggesting a role for microRNA in platelet regulation. Here we investigated potential associations between microRNA and platelet reactivity (PR), a marker o ...
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Journal ArticleJACC. Basic to translational science · April 2020
Cardiovascular (CV) disease remains an important cause of morbidity and mortality for patients with chronic kidney disease (CKD). Although clustering of traditional risk factors with CKD is well recognized, kidney-specific mechanisms are believed to drive ...
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Journal ArticleCirculation · March 10, 2020
Responding to concerns about the potential for increased risk of adverse cardiovascular outcomes, specifically myocardial infarction, associated with certain glucose-lowering therapies, the US Food and Drug Administration and the Committee for Medicinal Pr ...
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Journal ArticleContemp Clin Trials Commun · March 2020
BACKGROUND/AIMS: Numerous reasons have been identified for why U.S.-based principal investigators choose to not continue participating in FDA-regulated trials. However, unexplored are reasons why a substantial number of principal investigators, facing the ...
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Journal ArticleJACC CardioOncol · March 2020
OBJECTIVES: This study will compare the incidence of major adverse cardiovascular events (MACEs) with androgen deprivation therapy (ADT) among men with advanced prostate cancer who are being treated with a gonadotropin-releasing hormone (GnRH) antagonist v ...
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Journal ArticleUrol Oncol · February 2020
Prostate cancer (PCa) is the most common cancer among men. Advances in early detection and successful treatments have improved cancer-specific survival. With prolonged survival, PCa patients now suffer from the effects of aging and are at increasing risk f ...
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Journal ArticleJ Am Coll Cardiol · January 21, 2020
BACKGROUND: Lipoprotein(a) concentration is associated with cardiovascular events. Alirocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, lowers lipoprotein(a) and low-density lipoprotein cholesterol (LDL-C). OBJECTIVES: A pre-specified ana ...
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Journal ArticleCirculation · December 17, 2019
BACKGROUND: Lowering of atherogenic lipoproteins, including low-density lipoprotein cholesterol (LDL-C), reduces the risk of ischemic stroke. However, concerns have been raised about very low LDL-C levels and a potential increased risk of hemorrhagic strok ...
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Journal ArticleContemp Clin Trials Commun · December 2019
The Clinical Trials Transformation Initiative (CTTI) Strengthening the Investigator Community Project was prompted by the need to understand the reasons for high rates of turnover among investigators who lead US Food and Administration-regulated clinical t ...
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Journal ArticleAm Heart J · December 2019
BACKGROUND: Medicare insurance claims may provide an efficient means to ascertain follow-up of older participants in clinical research. We sought to determine the accuracy and completeness of claims- versus site-based follow-up with clinical event committe ...
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Journal ArticleCirculation · November 5, 2019
BACKGROUND: The 2018 US cholesterol management guidelines recommend additional lipid-lowering therapies for secondary prevention in patients with low-density lipoprotein cholesterol ≥70 mg/dL or non-high-density lipoprotein cholesterol ≥100 mg/dL despite m ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · November 2019
BACKGROUND: In ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab), alirocumab was compared with placebo, added to high-intensity or maximum tolerated statin treatment after acute coron ...
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Journal ArticleCirculation · October 22, 2019
The complexity and costs associated with traditional randomized, controlled trials have increased exponentially over time, and now threaten to stifle the development of new drugs and devices. Nevertheless, the growing use of electronic health records, mobi ...
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Journal ArticleAtherosclerosis · October 2019
BACKGROUND AND AIMS: There are limited data from the US on outcomes of patients in specialty care for familial hypercholesterolemia (FH). METHODS: CASCADE FH Registry data were analyzed to assess longitudinal changes in medication usage, in low density lip ...
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Journal ArticlePhysiol Genomics · October 1, 2019
The genomic regulatory networks underlying the pathogenesis of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are incompletely understood. As intermediate traits, protein biomarkers report on underlying disease severity and prognosis in NSTE-A ...
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Journal ArticleCirculation · September 24, 2019
Aspirin is the cornerstone of the antithrombotic management of patients with established atherosclerotic cardiovascular disease, but major guidelines provide conflicting recommendations for its use in primary prevention. Findings from recent randomized tri ...
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Journal ArticleJ Am Coll Cardiol · September 3, 2019
BACKGROUND: Patients with acute coronary syndrome (ACS) and concomitant noncoronary atherosclerosis have a high risk of major adverse cardiovascular events (MACEs) and death. The impact of lipid lowering by proprotein convertase subtilisin-kexin type 9 inh ...
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Journal ArticleJ Am Heart Assoc · September 3, 2019
Background Little is known regarding use of cardiac therapies and clinical outcomes among older myocardial infarction (MI) patients with cognitive impairment. Methods and Results Patients ≥65 years old with MI in the NCDR (National Cardiovascular Data Regi ...
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Journal ArticleJ Am Coll Cardiol · September 3, 2019
BACKGROUND: Patients with acute coronary syndrome (ACS) and history of coronary artery bypass grafting (CABG) are at high risk for recurrent cardiovascular events and death. OBJECTIVES: This study sought to determine the clinical benefit of adding alirocum ...
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Journal ArticleEur Heart J · September 1, 2019
AIMS: The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related ...
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Journal ArticleContemp Clin Trials Commun · September 2019
BACKGROUND: High turnover rates among clinical trial investigators contribute to inefficiency, instability, and increased costs for the clinical research enterprise; however, factors contributing to investigator turnover have not been well characterized. M ...
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Journal ArticleClin Trials · August 2019
BACKGROUND/AIMS: Health plan administrative claims data present a cost-effective complement to traditional trial-specific ascertainment of clinical events typically conducted through patient report or a single health system electronic health record. We aim ...
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Journal ArticleAm Heart J · August 2019
BACKGROUND: Little is known about the proportion of hospitals in the United States that offer clinical trial enrollment opportunities and how patient outcomes differ between hospitals that do and do not participate in clinical trials. METHODS: In the natio ...
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Journal ArticleLancet Diabetes Endocrinol · August 2019
BACKGROUND: After acute coronary syndrome, diabetes conveys an excess risk of ischaemic cardiovascular events. A reduction in mean LDL cholesterol to 1·4-1·8 mmol/L with ezetimibe or statins reduces cardiovascular events in patients with an acute coronary ...
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Journal ArticleCirculation · July 9, 2019
BACKGROUND: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrom ...
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ConferenceJAMA Cardiol · July 1, 2019
IMPORTANCE: Physician behavior in response to knowledge of a patient's CYP2C19 clopidogrel metabolizer status is unknown. OBJECTIVE: To investigate the association of mandatory reporting of CYP2C19 pharmacogenomic testing, provided to investigators with no ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · July 2019
BACKGROUND: The benefit of β-blocker use beyond 3 years after a myocardial infarction (MI) has not been clearly determined. METHODS AND RESULTS: Using data from the CRUSADE Registry (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Advers ...
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Journal ArticleAm J Cardiol · April 15, 2019
Risk prediction following acute coronary syndrome (ACS) remains challenging. Data-driven machine-learning algorithms can potentially identify patients at high risk of clinical events. The Improved Reduction of Outcomes: Vytorin Efficacy International Trial ...
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Journal ArticleCan J Cardiol · April 2019
BACKGROUND: The effect of sex on self-reported frailty in acute coronary syndromes (ACS) is unclear. We examined the prevalence of self-reported frailty and its association with all-cause death among men and women. METHODS: Elderly (≥ 65 years) male (n = 2 ...
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Journal ArticleClin Cardiol · March 2019
BACKGROUND: Little is known about how differences in out of hospital cardiac arrest patient volume affect in-hospital myocardial infarction (MI) mortality. HYPOTHESIS: Hospitals accepting cardiac arrest transfers will have increased hospital MI mortality. ...
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Journal ArticleCirculation · February 12, 2019
BACKGROUND: Modern cardiometabolic clinical trials often include cardiovascular death as a component of a composite primary outcome, requiring central adjudication by a clinical events committee to classify cause of death. However, sometimes the cause of d ...
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Journal ArticleJ Am Coll Cardiol · February 5, 2019
BACKGROUND: The ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial compared alirocumab with placebo, added to high-intensity or maximum-tolerated statin treatment, after acute co ...
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Journal ArticleCirculation · January 22, 2019
BACKGROUND: Although many studies show an inverse association between operator procedural volume and short-term adverse outcomes after percutaneous coronary intervention (PCI), the association between procedural volume and longer-term outcomes is unknown. ...
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Journal ArticleInt J Cardiol · January 1, 2019
BACKGROUND: Myocardial infarction (MI) presentations are more common during winter months and morning hours. However, it is unknown whether MI with obstructive coronary artery disease (MI-CAD) and non-obstructive CAD (MINOCA) display similar patterns. METH ...
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Journal ArticleClin Cardiol · January 2019
BACKGROUND: In ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI), current oral P2Y12 platelet inhibitors do not provide maximal platelet inhibition at the time of reperfusion. Further ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · January 2019
BACKGROUND: Although cholesterol-lowering medications can reduce the risk of recurrent cardiovascular events, premature discontinuation limits effectiveness. Discontinuation rates have not been systematically reported for lipid-lowering trials. METHODS AND ...
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Journal ArticleJ Am Heart Assoc · December 18, 2018
Background We sought to determine temporal trends in use of evidence-based therapies and clinical outcomes among myocardial infarction ( MI) patients with chronic kidney disease ( CKD ). Methods and Results MI patients from the NCDR (National Cardiovascula ...
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Journal ArticleAm Heart J · December 2018
Contemporary utilization patterns for targeted temperature management (TTM) among patients with acute myocardial infarction (MI) and out-of-hospital cardiac arrest (OHCA) have not been well characterized in the United States. In this nationwide evaluation ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · December 2018
Background Cardiovascular clinical trials have traditionally incorporated separate time-to-first-event analyses for their primary efficacy and safety comparisons, but this framework has a number of limitations, including limited patient-centeredness and a ...
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Journal ArticleN Engl J Med · November 29, 2018
BACKGROUND: Patients who have had an acute coronary syndrome are at high risk for recurrent ischemic cardiovascular events. We sought to determine whether alirocumab, a human monoclonal antibody to proprotein convertase subtilisin-kexin type 9 (PCSK9), wou ...
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Journal ArticleJACC Cardiovasc Interv · November 26, 2018
OBJECTIVES: The aim of this study was to determine whether frailty is associated with increased bleeding risk in the setting of acute myocardial infarction (AMI). BACKGROUND: Frailty is a common syndrome in older adults. METHODS: Frailty was examined among ...
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Journal ArticleAm J Cardiol · November 1, 2018
The natural history of patients hospitalized for acute coronary syndrome (ACS) with pre-existing versus (vs) de novo heart failure (HF) has not been previously reported over an extended duration of follow-up. The IMPROVE-IT trial enrolled 18,144 patients h ...
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Journal ArticleAm J Cardiol · October 15, 2018
Patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) are sometimes treated with medical management alone rather than an invasive strategy. Among those medically managed without revascularization and discharged, a proportion will requi ...
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Journal ArticleJACC Cardiovasc Interv · September 24, 2018
OBJECTIVES: The aim of this study was to describe the prevalence of pre-hospital cardiac catheterization laboratory activation and its association with reperfusion timeliness and in-hospital mortality. BACKGROUND: For patients with ST-segment elevation myo ...
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Journal ArticleCoron Artery Dis · September 2018
BACKGROUND: In the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial of patients with non-ST-segment elevation acute coronary syndrome managed medically without revascularization, ...
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Journal ArticleClin Cardiol · September 2018
BACKGROUND: Comorbid condition and hospital risk-adjusted outcomes prevalence were compared based on clinical registry vs administrative claims data. HYPOTHESIS: Risk-adjusted outcomes will vary depending on the source of comorbidity data used. METHODS: Cl ...
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Journal ArticleJ Am Heart Assoc · August 21, 2018
Background Epidemiological studies demonstrating a relationship between gout and cardiovascular disease are older and predate modern cardiovascular preventive therapy. We assessed the contemporary association between gout and cardiovascular disease in pati ...
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Journal ArticleAm Heart J · July 2018
BACKGROUND: Patients with peripheral artery disease (PAD) are known to have an increased risk of ischemic cardiovascular events. However, the influence of concomitant PAD on first and subsequent recurrent ischemic events after an acute coronary syndrome (A ...
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Journal ArticleJ Am Heart Assoc · June 30, 2018
BACKGROUND: There is limited information about the long-term survival of older patients after myocardial infarction (MI). METHODS AND RESULTS: CRUSADE (Can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implement ...
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Journal ArticleJ Am Coll Cardiol · June 12, 2018
As we enter the information age of health care, digital health technologies offer significant opportunities to optimize both clinical care delivery and clinical research. Despite their potential, the use of such information technologies in clinical care an ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · June 2018
BACKGROUND: Patients living in disadvantaged neighborhoods are at high risk for adverse outcomes after acute myocardial infarction (MI). Whether residential socioeconomic status (SES) is associated with quality of in-hospital care among patients presenting ...
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Journal ArticleEuroIntervention · May 20, 2018
AIMS: The aim of this meta-analysis was to compare the benefit of "early" vs. "delayed" P2Y12 inhibition in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: We conducted a met ...
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Journal ArticleCirc Cardiovasc Interv · May 2018
BACKGROUND: Early success with regionalization of ST-segment-elevation myocardial infarction (STEMI) care has led many states to adopt statewide prehospital STEMI hospital destination policies, allowing emergency medical services to bypass non-percutaneous ...
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Journal ArticleAm Heart J · March 2018
BACKGROUND: Assessing hospital-related network-level primary percutaneous coronary intervention (PCI) performance for ST-segment elevation myocardial infarction (STEMI) is challenging due to differential time-to-treatment metrics based on location of diagn ...
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Journal ArticleJACC Cardiovasc Interv · February 26, 2018
OBJECTIVES: The study sought to characterize patient- and hospital-level variation in early angiography use among non-ST-segment elevation myocardial infarction (NSTEMI) patients. BACKGROUND: Contemporary implementation of guideline recommendations for ear ...
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Journal ArticleEur Heart J · January 14, 2018
AIMS: We sought to determine the association of clopidogrel reloading with in-hospital bleeding and mortality in contemporary practice. METHODS AND RESULTS: We examined clopidogrel reloading for ST-segment elevation myocardial infarction (STEMI) and non-ST ...
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Journal ArticleEur Heart J Qual Care Clin Outcomes · January 1, 2018
AIMS: To examine the association of acute kidney injury (AKI) with long-term outcomes after myocardial infarction (MI), and evaluate whether effect modification is present according to baseline chronic kidney disease (CKD) status. METHODS AND RESULTS: ACTI ...
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Journal ArticleAtherosclerosis · December 2017
BACKGROUND AND AIMS: Most familial hypercholesterolemia (FH) patients remain undertreated, and it is unclear what role health disparities may play for FH patients in the US. We sought to describe sex and racial/ethnic disparities in a national registry of ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · December 2017
BACKGROUND: Sex differences in early mortality after myocardial infarction (MI) vary by age. MI with nonobstructive coronary arteries (MINOCA [<50% stenosis]) is more common among younger patients and women, and MINOCA has a better prognosis than MI with o ...
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Journal ArticleJ Am Heart Assoc · October 11, 2017
BACKGROUND: Patients with ST-elevation myocardial infarction (STEMI) with out-of-hospital cardiac arrest (OHCA) may benefit from direct transport to a percutaneous cardiac intervention (PCI) hospital but have previously been less likely to bypass local non ...
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Journal ArticleJ Am Soc Nephrol · October 2017
Efficacy of statin-based therapies in reducing cardiovascular mortality in individuals with CKD seems to diminish as eGFR declines. The strongest evidence supporting the cardiovascular benefit of statins in individuals with CKD was shown with ezetimibe plu ...
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Journal ArticleClin Cardiol · October 2017
BACKGROUND: In 2011, the US Food and Drug Administration requested that GlaxoSmithKline perform retrospective adjudication of cardiovascular (CV) events reported in the bupropion drug-development trials for smoking cessation. HYPOTHESIS: Retrospective adju ...
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Journal ArticleJ Am Heart Assoc · September 18, 2017
BACKGROUND: Understanding the relative risk of cardiovascular versus noncardiovascular death is important for designing clinical trials. These risks may differ depending on patient age, sex, and type of acute coronary syndrome (ACS). METHODS AND RESULTS: I ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · September 2017
BACKGROUND: Practice patterns in anticoagulant strategies used during percutaneous coronary intervention (PCI) in the United States for patients with non-ST-segment-elevation myocardial infarction and the comparative outcomes between bivalirudin and unfrac ...
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Journal ArticleInt J Cardiol · August 15, 2017
BACKGROUND: Nine oral antithrombotic medications currently available in the United States and Europe have been studied in clinical trials for secondary prevention of cardiac events following acute coronary syndrome (ACS). Few combinations of these medicati ...
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Journal ArticleHeart · August 2017
OBJECTIVES: Dual antiplatelet therapy (DAPT) with aspirin + a P2Y12 inhibitor is recommended for at least 12 months for patients with acute coronary syndrome (ACS), with shorter durations considered for patients with increased bleeding risk. However, there ...
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Journal ArticleCardiovasc Drugs Ther · August 2017
PURPOSE: The need for novel approaches to cardiovascular drug development served as the impetus to convene an open meeting of experts from the pharmaceutical industry and academia to assess the challenges and develop solutions for drug discovery in cardiov ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · August 2017
BACKGROUND: There are limited data on the utilization and outcomes of coronary artery bypass grafting (CABG) among ST-segment-elevation myocardial infarction (STEMI) patients in contemporary practice. METHODS AND RESULTS: Using data from National Cardiovas ...
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Journal ArticleClin Chem · July 2017
BACKGROUND: There are conflicting data on whether changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) concentrations between time points (delta NT-proBNP and hs-CRP) are associated with a change ...
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Journal ArticleJ Am Coll Cardiol · June 20, 2017
BACKGROUND: Professional guidelines have reduced the recommended minimum number to an average of 50 percutaneous coronary intervention (PCI) procedures performed annually by each operator. Operator volume patterns and associated outcomes since this change ...
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Journal ArticleContemp Clin Trials Commun · June 2017
Concerns have been raised over the high turnover rate for clinical investigators. Using the U.S. Food and Drug Administration's (FDA) Bioresearch Monitoring Information System database, we conducted an online survey to identify factors that affect principa ...
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Journal ArticleAm Heart J · June 2017
OBJECTIVE: Patients with diabetes mellitus (DM) presenting with acute coronary syndrome (ACS) and undergoing percutaneous coronary intervention (PCI) derived enhanced benefit with dual antiplatelet therapy (DAPT) with prasugrel vs. clopidogrel. The risk pr ...
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Journal ArticleAtherosclerosis · June 2017
BACKGROUND AND AIMS: Although circulating microRNA (miRNAs) have emerged as biomarkers predicting mortality in acute coronary syndrome (ACS), more data are needed to understand these mechanisms. Mapping miRNAs to high-risk traits may identify miRNAs involv ...
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Journal ArticleLancet · May 6, 2017
BACKGROUND: Dual antiplatelet therapy (DAPT), aspirin plus a P2Y12 inhibitor, is the standard antithrombotic treatment following acute coronary syndromes. The factor Xa inhibitor rivaroxaban reduced mortality and ischaemic events when added to DAPT, but ca ...
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Journal ArticleAm Heart J · May 2017
OBJECTIVE: Acute coronary syndrome (ACS) trials typically use a composite primary outcome (myocardial infarction [MI], stroke, or cardiovascular death), but differential patient characteristics, timing, and consequences associated with individual component ...
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Journal ArticleAm Heart J · May 2017
BACKGROUND: Studies have suggested a relationship between higher baseline serum uric acid (sUA) levels and an elevated risk of subsequent ischemic cardiovascular outcomes among acute coronary syndrome (ACS) patients; this relationship may be modified by a ...
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Journal ArticleAm J Cardiol · April 15, 2017
Clinical outcomes in acute myocardial infarction (AMI) worsen with increasing delay between symptom onset and clinical presentation. Previous studies have shown that black patients with AMI have longer presentation delays. The objective of this analysis is ...
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Journal ArticleJ Am Heart Assoc · April 11, 2017
BACKGROUND: The relationship between troponin level and outcomes among patients with non-ST-segment elevation ACS is established, but the relationship of troponin level with long-term outcomes among medically managed non-ST-segment elevation ACS patients r ...
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Journal ArticleJACC Cardiovasc Interv · April 10, 2017
OBJECTIVES: This study sought to determine variability and stability in risk-standardized mortality rates (RSMR) of percutaneous coronary intervention (PCI) operators meeting minimum case volume standards and identify differences in case mix and practice p ...
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Journal ArticleClin Trials · April 2017
BACKGROUND AND PURPOSE: Data monitoring committees are responsible for safeguarding the interests of study participants and assuring the integrity and credibility of clinical trials. The independence of data monitoring committees from sponsors and investig ...
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Journal ArticleCirc Cardiovasc Interv · April 2017
BACKGROUND: Acute kidney injury (AKI) remains a common complication after percutaneous coronary intervention (PCI) and is associated with adverse in-hospital patient outcomes. The incidence of adverse events after hospital discharge in patients having post ...
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Journal ArticleJ Am Coll Cardiol · March 28, 2017
BACKGROUND: Sex-specific differences in response to antiplatelet therapies have been described. Whether women and men derive comparable benefit from intensification of antiplatelet therapy remains uncertain. OBJECTIVES: The study investigated the efficacy ...
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Journal ArticleJ Am Coll Cardiol · March 21, 2017
Cardiovascular disease is a leading cause of death and disability in the United States. National programs, such as the National Cardiovascular Data Registry, facilitate assessments of the quality of care and outcomes for broad populations of patients with ...
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Journal ArticleClin Trials · February 2017
BACKGROUND: Patients with cardiac arrest and other life-threatening emergencies are unable to provide prospective consent for clinical trials. In the United States and other countries, regulations permit an exception from the requirement for informed conse ...
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Journal ArticleJ Am Heart Assoc · January 11, 2017
BACKGROUND: Emergent myocardial reperfusion via primary percutaneous coronary intervention is optimal care for patients presenting with ST-segment elevation myocardial infarction (STEMI). Delays in such interventions are associated with increases in mortal ...
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Journal ArticleCurr Pharm Des · 2017
The efficacy of antiplatelet therapy for the secondary prevention of cardiovascular disease after an ischemic event is well established. However, the role for antiplatelet therapy for the primary prevention of cardiovascular disease is more complex because ...
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Journal ArticleJ Electrocardiol · 2017
AIMS: ST-segment recovery (STR) is a strong mechanistic correlate of infarct size (IS) and outcome in ST-segment elevation myocardial infarction (STEMI). Characterizing measures of speed, amplitude, and completeness of STR may extend the use of this noninv ...
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Journal ArticleJACC Cardiovasc Interv · December 12, 2016
OBJECTIVES: The purpose of this study was to describe temporal trends and determine the comparative effectiveness of bivalirudin versus unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarct ...
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Journal ArticleJ Am Heart Assoc · November 4, 2016
BACKGROUND: The relationship between "on-treatment" low platelet reactivity and longitudinal risks of major bleeding dual antiplatelet therapy following acute coronary syndromes remains uncertain, especially for patients who do not undergo percutaneous cor ...
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Journal ArticleAm Heart J · November 2016
Aspirin was established more than a quarter century ago as an evidence-based therapy to reduce recurrent cardiovascular events in patients with coronary artery disease based on limited data by contemporary standards. Indeed it is unclear how regulatory age ...
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Journal ArticleJ Am Coll Cardiol · October 25, 2016
Large randomized clinical trials in cardiovascular disease have proliferated over the past 3 decades, with results that have influenced every aspect of cardiology practice. Despite these advances, there remains a substantial need for more high-quality evid ...
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ConferenceEur Heart J Acute Cardiovasc Care · October 2016
AIMS: We aimed to study the relationship of chronic kidney disease stages with long-term ischemic and bleeding outcomes in medically managed acute coronary syndrome patients and the influence of more potent antiplatelet therapies on platelet reactivity by ...
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Journal ArticleAm Heart J · October 2016
BACKGROUND: Hospital mortality is an important quality measure for acute myocardial infarction care. There is a concern that despite risk adjustment, percutaneous coronary intervention hospitals accepting a greater volume of high-risk ST elevation myocardi ...
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Journal ArticleAm J Cardiol · October 1, 2016
In 2006, the United States (US) Food and Drug Administration published advisory highlighting concerns for late drug-eluting stent thrombosis; its impact on US bare-metal stent (BMS) utilization is unknown. We examined rates of BMS use among Medicare patien ...
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Journal ArticleJ Am Heart Assoc · September 13, 2016
BACKGROUND: The PCSK9 antibody alirocumab (75 mg every 2 weeks; Q2W) as monotherapy reduced low-density lipoprotein-cholesterol (LDL-C) levels by 47%. Because the option of a monthly dosing regimen is convenient, ODYSSEY CHOICE II evaluated alirocumab 150 ...
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Journal ArticleClin Cardiol · September 2016
Associations between atrial fibrillation (AF), outcomes, and response to antiplatelet therapies in patients with acute coronary syndrome (ACS) managed medically without revascularization remain uncertain. We examined these associations for medically manage ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · September 2016
BACKGROUND: Among older patients with acute myocardial infarction (MI), it remains uncertain whether there is a time-dependent difference in the risk of recurrent mortality and nonfatal cardiovascular and cerebrovascular events for those with ST-segment-el ...
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Journal ArticleJACC Cardiovasc Interv · August 22, 2016
OBJECTIVES: This study sought to examine predictors, trends, and outcomes associated with β-blocker prescriptions at discharge in patients with stable angina without prior history of myocardial infarction (MI) or systolic heart failure (HF) undergoing elec ...
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Journal ArticleHeart · August 1, 2016
OBJECTIVE: We investigated whether prior clopidogrel influenced long-term ischaemic and bleeding risks and modified the randomised treatment effect of clopidogrel versus prasugrel among medically managed patients with acute coronary syndromes (ACS) treated ...
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Journal ArticleDrug Saf · August 2016
Aspirin has been the cornerstone of therapy for the secondary prevention treatment of patients with cardiovascular disease since landmark trials were completed in the late 1970s and early 1980s that demonstrated the efficacy of aspirin for reducing the ris ...
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Journal ArticleAm Heart J · August 2016
BACKGROUND: Few studies have assessed treatment effects on health-related quality of life (HRQoL) in patients with acute coronary syndrome (ACS) treated without revascularization. The TRILOGY ACS trial randomized patients with ACS to either prasugrel or cl ...
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Journal ArticleAm J Cardiol · August 1, 2016
Young patients with acute myocardial infarction (MI) have a more favorable prognosis than older patients with MI. However, there are limited data comparing the prognosis of young patients with MI with young population controls. Comparison with an age-match ...
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Journal ArticleEur Heart J Acute Cardiovasc Care · June 2016
AIMS: Little is known regarding consequences of frailty in patients with acute coronary syndrome (ACS). We assessed the associations of frailty and outcomes in ACS patients who were participating in a clinical trial. METHODS AND RESULTS: The TaRgeted plate ...
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Journal ArticleCoron Artery Dis · June 2016
For patients with a non-ST-segment elevation acute coronary syndrome (NSTE-ACS), guideline recommendations and treatment pathways focus on revascularization for definitive treatment if the patient is an appropriate candidate. Despite the widespread use of ...
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Journal ArticleCirc Cardiovasc Genet · June 2016
BACKGROUND: Cardiovascular disease burden and treatment patterns among patients with familial hypercholesterolemia (FH) in the United States remain poorly described. In 2013, the FH Foundation launched the Cascade Screening for Awareness and Detection (CAS ...
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Journal ArticleAm Heart J · June 2016
BACKGROUND: We explored the risks/benefits of revascularization versus medical management in syncope patients with obstructive coronary artery disease (CAD). METHODS: We retrospectively examined Medicare patients ≥65 years undergoing percutaneous coronary ...
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Journal ArticleClin Cardiol · June 2016
BACKGROUND: Low levels of high-density lipoprotein cholesterol (HDL-C; <40 mg/dL) are associated with increased risk of cardiovascular events, but it is unclear whether lower thresholds (<30 mg/dL) are associated with increased hazard. HYPOTHESIS: Very low ...
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Journal ArticleAm Heart J · May 2016
BACKGROUND: Acute myocardial infarction (AMI) has become a major cause of hospitalization and mortality in China. There has been limited data to date available to characterize AMI presentation, contemporary patterns of medical care, and outcomes in China. ...
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Journal ArticleAm Heart J · May 2016
BACKGROUND: Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines (ACTION Registry-GWTG) was designed to measure and improve the treatment and outcomes of patients with acute myocardial infarction (AMI), yet it is unkn ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · May 2016
BACKGROUND: Current guidelines recommend surgical revascularization (coronary artery bypass graft [CABG]) over percutaneous coronary intervention (PCI) in patients with diabetes mellitus and multivessel coronary artery disease. Few data are available descr ...
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Journal ArticleJACC Cardiovasc Interv · April 25, 2016
OBJECTIVES: The aim of this study was to explore whether the use of bleeding avoidance strategies (BAS) explains variability in hospital-level bleeding following percutaneous coronary intervention. BACKGROUND: Prior studies have reported that bleeding rate ...
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Journal ArticleStroke · April 2016
BACKGROUND AND PURPOSE: The role of more intense, sustained platelet inhibition in preventing stroke after acute coronary syndrome (ACS) is unclear. We observed a signal for reduced stroke risk in the Targeted Platelet Inhibition to Clarify the Optimal Str ...
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Journal ArticleAm Heart J · April 2016
BACKGROUND: Adverse event collection in randomized clinical trials establishes drug safety. Although costly and regulated, it is rarely studied. METHODS: Adverse event data from 4 clinical trials (APPRAISE-2, PLATO, TRACER, TRILOGY ACS) comprising 48,118 p ...
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Journal ArticleAm Heart J · April 2016
Dual antiplatelet therapy (DAPT), the combination of aspirin and a P2Y12 inhibitor, given for 12 months remains the standard of care after presentation with acute coronary syndrome (ACS) because it has been shown to be associated with a significant reducti ...
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Journal ArticleCirc Cardiovasc Interv · April 2016
BACKGROUND: Bleeding is associated with poor outcomes after percutaneous coronary intervention (PCI). Although arterial closure devices (ACDs) are widely used in clinical practice, whether they are effective in reducing bleeding complications during transf ...
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Journal ArticleJAMA Cardiol · April 1, 2016
IMPORTANCE: In the current therapeutic era, the risk for sudden cardiac death (SCD) after non-ST-segment elevation acute coronary syndrome (NSTE ACS) has not been characterized completely. OBJECTIVE: To determine the cumulative incidence of SCD during long ...
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Journal ArticleJ Am Coll Cardiol · March 22, 2016
BACKGROUND: Patients with acute coronary syndrome (ACS), especially those receiving medical management without revascularization, are at high risk for spontaneous myocardial infarction (MI), but its frequency and predictors are unknown. OBJECTIVES: This st ...
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Journal ArticleJ Am Heart Assoc · March 14, 2016
BACKGROUND: While use of P2Y12 receptor inhibitor is recommended by guidelines, few studies have examined its effectiveness among older non-ST-segment elevation myocardial infarction patients who did not undergo coronary revascularization. METHODS AND RESU ...
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Journal ArticleJ Am Coll Cardiol · March 1, 2016
BACKGROUND: Certain alleles of the CYP2C19 gene are associated with higher platelet reactivity and increased ischemic events among patients treated with clopidogrel. However, the relationship of CYP2C19 genotype and outcomes in medically managed patients w ...
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Journal ArticleCirc Cardiovasc Interv · March 2016
BACKGROUND: Because of recent changes in criteria for coverage for inpatient hospital stays, most nonacute percutaneous coronary intervention (PCI) procedures are reimbursed on an outpatient basis regardless of underlying patient risk. Downstream effects o ...
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Journal ArticleJACC Cardiovasc Interv · February 22, 2016
OBJECTIVES: The purpose of this study was to examine the temporal trends in demographics, clinical characteristics, management strategies, and in-hospital outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (CS-AMI) who u ...
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Journal ArticleAm Heart J · February 2016
BACKGROUND: Older adults presenting with acute myocardial infarction (MI) often have multivessel coronary artery disease amenable to percutaneous coronary intervention (PCI), yet the risks of multivessel intervention may outweigh potential benefits in thes ...
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Journal ArticleEur Heart J · January 21, 2016
AIMS: Studies have suggested increased cancer incidence associated with long-term dual antiplatelet therapy (DAPT) for acute coronary syndrome (ACS). We evaluated cancer incidence and treatment-related differences in an analysis of DAPT for ACS. METHODS AN ...
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Journal ArticleIndian Heart J · 2016
OBJECTIVE: To analyze trends in utilization of anti-thrombotic agents (ATA) and in-hospital clinical outcomes in non-ST-elevation myocardial infarction (NSTEMI) patients managed with an invasive strategy from 2007 to 2010. METHODS & RESULTS: Using ACTION R ...
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Journal ArticleJ Clin Lipidol · 2016
BACKGROUND: In the US familial hypercholesterolemia (FH), patients are underidentified, despite an estimated prevalence of 1:200 to 1:500. Criteria to identify FH patients include Simon Broome, Dutch Lipid Clinic Network (DLCN), or Make Early Diagnosis to ...
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Journal ArticleClin Cardiol · December 2015
BACKGROUND: Interhospital transfer invasive management patterns and implications for older non-ST-segment elevation myocardial infarction (NSTEMI) patients initially presenting to non-revascularization-capable hospitals have not been explored. HYPOTHESIS: ...
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Journal ArticleClin Cardiol · December 2015
BACKGROUND: Practice guidelines recommend an early invasive strategy for high-risk non-ST-segment elevation myocardial infarction (NSTEMI) patients, but international differences in the use of invasive strategies are unknown. HYPOTHESIS: Profiling NSTEMI p ...
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Journal ArticleAm Heart J · December 2015
BACKGROUND: Details on Japanese patients undergoing percutaneous coronary intervention (PCI) and how they compare to US patients remain unclear. Furthermore, the application of US risk models has not been evaluated internationally. METHODS: The JCD-KiCS, a ...
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Journal ArticleAmerican heart journal · October 2015
BackgroundWomen with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. W ...
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Journal ArticleAm Heart J · October 2015
UNLABELLED: Concomitant use of proton-pump inhibitors (PPIs) has been implicated in diminished antiplatelet response to clopidogrel and an increased risk of ischemic events, but primarily among patients undergoing percutaneous coronary intervention. We sou ...
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Journal ArticleCirc Cardiovasc Interv · September 2015
BACKGROUND: For patients with ST-segment-elevation myocardial infarction (STEMI) requiring interhospital transfer for primary percutaneous coronary intervention, direct transfer from the STEMI referral hospital to the catheterization laboratory (cath lab) ...
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Journal ArticleAm Heart J · August 2015
BACKGROUND: Prior work has demonstrated that adherence to American College of Cardiology/American Heart Association guideline recommendations is associated with decreased in-hospital mortality in non-ST-segment elevation myocardial infarction (NSTEMI) pati ...
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Journal ArticleJ Am Heart Assoc · July 6, 2015
BACKGROUND: Cardiovascular disease and cancer increasingly coexist, yet relationships between cancer and long-term cardiovascular outcomes post-percutaneous coronary intervention (PCI) are not well studied. METHODS AND RESULTS: We examined stented PCI pati ...
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Journal ArticleJ Am Heart Assoc · June 18, 2015
BACKGROUND: Little is known about the incidence, predictors, or outcomes of intracranial hemorrhage (ICH) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). We aimed to determine the incidence and timing of ICH, characterize the ...
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Journal ArticleAm J Cardiol · June 15, 2015
Elevated low-density lipoprotein cholesterol (LDL-C) is associated with increased risk of myocardial infarction and is a target for disease prevention. The association between initial LDL-C and statin treatment in patients with non-ST-segment elevation myo ...
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Journal ArticleAm J Med · June 2015
BACKGROUND: Age is associated with outcomes in non-ST-segment elevation myocardial infarction; however, less is known about rehospitalization or death among elderly survivors. We aimed to evaluate mortality and cause-specific rehospitalization rates in thi ...
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Journal ArticleAm Heart J · June 2015
Recent developments have highlighted the challenges facing cardiovascular clinical research in global contemporary practice, particularly in North America, including shifting priorities for drug development targets, increasing regulatory requirements, and ...
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Journal ArticleJ Am Coll Cardiol · May 19, 2015
BACKGROUND: Rates of referral to cardiac rehabilitation after percutaneous coronary intervention (PCI) have been historically low despite the evidence that rehabilitation is associated with lower mortality in PCI patients. OBJECTIVES: This study sought to ...
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Journal ArticleCirc Cardiovasc Interv · May 2015
BACKGROUND: Current American College of Cardiology/American Heart Association guidelines recommend transfer and primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction (STEMI) patients within the time limit of first ...
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Journal ArticleDrug Saf · May 2015
The key pathophysiological process underlying symptomatic coronary artery disease, including acute coronary syndromes (ACS), is usually a rupture or an erosion of an atherosclerotic plaque, followed by platelet activation and subsequent thrombus formation. ...
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Journal ArticleJ Am Coll Cardiol · April 21, 2015
Despite the global burden of cardiovascular disease, investment in cardiovascular drug development has stagnated over the past 2 decades, with relative underinvestment compared with other therapeutic areas. The reasons for this trend are multifactorial, bu ...
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Journal ArticleAm Heart J · April 2015
BACKGROUND: Cardiac arrest (CA) is a major complication of patients with ST-elevation myocardial infarction (STEMI). Its prevalence and prognostic impact in contemporary US practice has not been well assessed. METHODS: We evaluated STEMI patients included ...
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Journal ArticleCirculation · March 17, 2015
BACKGROUND: Performance metrics currently focus on the measurement of the application of guideline-indicated medications without considering the appropriate dosing of these drugs. METHODS AND RESULTS: We studied 39 291 patients from the Can Rapid Risk Stra ...
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Journal ArticleEur Heart J · February 7, 2015
AIMS: Several methods provide new insights into understanding clinical trial composite endpoints, using both conventional and novel methods. The TRILOGY ACS trial is used as a contemporary example to prospectively compare these methods side by side. METHOD ...
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Journal ArticleJAMA Intern Med · February 2015
IMPORTANCE: Guidelines for patients with ST-segment elevation myocardial infarction (STEMI) recommend timely reperfusion with primary percutaneous coronary intervention (pPCI) or fibrinolysis. Among patients with STEMI who require interhospital transfer, i ...
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ConferenceAm Heart J · February 2015
BACKGROUND: Circulating levels of cardiac troponin I (cTnI) after ST-segment elevation myocardial infarction (STEMI) are associated with infarct size and chronic left ventricular dysfunction, but the relation to clinical end points and biochemical measures ...
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Journal ArticleHeart · February 2015
OBJECTIVE: To study the impact of national economic and human development status on patient profiles and outcomes in the setting of acute coronary syndrome (ACS). METHODS: We conducted a retrospective analysis of the Targeted Platelet Inhibition to Clarify ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · January 2015
BACKGROUND: The Dual Antiplatelet Therapy Study is large streamlined clinical trial designed to evaluate antiplatelet treatment strategies in a broadly inclusive population of subjects treated with coronary stents. Whether large streamlined trials can succ ...
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Journal ArticleCirc Cardiovasc Interv · December 2014
BACKGROUND: ST-segment myocardial infarction patients frequently present to non-percutaneous coronary intervention (PCI) hospitals and require interhospital transfer for primary PCI. The effect of distance and mode of transport to the PCI center and the fr ...
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Journal ArticleAm Heart J · November 2014
BACKGROUND: The Center for Medicare and Medicaid Services (CMS) publicly reports "core process of care measures" along with 30-day mortality rates for patients with acute myocardial infarction; the American College of Cardiology/American Heart Association ...
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Journal ArticleAm Heart J · November 2014
BACKGROUND: Following acute coronary syndrome (ACS), the risk for future cardiovascular events is high and is related to levels of low-density lipoprotein cholesterol (LDL-C) even within the setting of intensive statin treatment. Proprotein convertase subt ...
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Journal ArticleAm J Cardiol · October 15, 2014
Patients with diabetes mellitus (DM) presenting with acute myocardial infarction (AMI) have worse outcomes versus those without DM. Comparative contemporary data in patients presenting with AMI with insulin-requiring diabetes mellitus (IRDM), noninsulin-re ...
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Journal ArticleAm Heart J · October 2014
BACKGROUND: Peak creatine kinase (CK)-MB concentration is related to reperfusion success and clinical outcomes after fibrinolytic therapy for acute myocardial infarction. However, prognostic implications of CK-MB measurements after primary percutaneous cor ...
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Journal ArticleEur Heart J · October 1, 2014
AIMS: Delcasertib is a selective inhibitor of delta-protein kinase C (delta-PKC), which reduced infarct size during ischaemia/reperfusion in animal models and diminished myocardial necrosis and improved reperfusion in a pilot study during primary percutane ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · September 2014
BACKGROUND: Prior studies demonstrated that patients with ST-segment-elevation myocardial infarction presenting during off-hours (weeknights, weekends, and holidays) have slower reperfusion times. Recent nationwide initiatives have emphasized 24/7 quality ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · September 2014
BACKGROUND: Accumulated data suggest that low-dose aspirin after myocardial infarction (MI) may offer similar efficacy to higher dose aspirin with reduced risk of bleeding. Few data are available on contemporary aspirin dosing patterns after MI in the Unit ...
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Journal ArticleCirculation · August 19, 2014
BACKGROUND: Blacks are less likely than whites to receive coronary revascularization and evidence-based therapies after acute myocardial infarction, yet the impact of these differences on long-term outcomes is unknown. METHODS AND RESULTS: We linked Can Ra ...
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Journal ArticleInt J Cardiol · August 1, 2014
OBJECTIVES: To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries. BACKGROUND: Results from clinical trials suggest significant variation in care a ...
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Journal ArticleAm Heart J · August 2014
Independent data monitoring committees (IDMCs) were introduced to monitor patient safety and study conduct in randomized clinical trials (RCTs), but certain challenges regarding the utilization of IDMCs have developed. First, the roles and responsibilities ...
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Journal ArticleInternational Journal of Cardiology · August 1, 2014
Objectives To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries. Background Results from clinical trials suggest significant variation in care acr ...
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Journal ArticleCirc Cardiovasc Interv · August 2014
BACKGROUND: Although randomized clinical trials have compared clopidogrel with higher potency ADP receptor inhibitors (ADPris) among patients with myocardial infarction, little is known about the frequency and factors associated with switching between ADPr ...
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Journal ArticleAm J Cardiol · July 1, 2014
The percentage of patients with primary percutaneous coronary intervention (PCI) with door-to-balloon (D2B) times ≤90 minutes is used as a hospital performance measure for public reporting. Patients can be excluded from reporting for nonsystem-related dela ...
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ConferenceAm Heart J · July 2014
BACKGROUND: To further explore the impact of smoking on antiplatelet activity and treatment response, we evaluated time-dependent relationships between smoking status with on-treatment platelet reactivity and clinical outcomes for prasugrel vs. clopidogrel ...
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Journal ArticleAm Heart J · June 2014
BACKGROUND: Timely and appropriate use of antiplatelet and anticoagulant therapies has been shown to improve outcomes among ST-segment elevation myocardial infarction (STEMI) patients but has not been well described in patients transferred for primary perc ...
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Journal ArticleAm Heart J · June 2014
BACKGROUND: Guidelines recommend noninvasive tests (NITs) to risk stratify and identify patients with higher likelihood of coronary artery disease (CAD) prior to elective coronary angiography. However, a high percentage of patients are found to have nonobs ...
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Journal ArticleAm Heart J · June 2014
BACKGROUND: Prior myocardial infarction (MI) is a known risk factor for long-term mortality among acute MI patients; but its prevalence and implications for the short-term outcomes of patients with a new, acute MI remain uncertain. METHODS: We studied a to ...
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Journal ArticleAm Heart J · May 2014
BACKGROUND: Prior studies have found that academic hospitals provide more consistent use of guideline-recommended therapies in patients with non-ST-segment myocardial infarction (NSTEMI) compared with nonacademic centers, yet it is unclear whether these ca ...
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Journal ArticleJ Am Heart Assoc · April 14, 2014
BACKGROUND: P2Y12 antagonist therapy improves outcomes in acute myocardial infarction (MI) patients. Novel agents in this class are now available in the US. We studied the introduction of prasugrel into contemporary MI practice to understand the appropriat ...
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Journal ArticleAm J Cardiol · April 1, 2014
Outcomes in patients with out-of-hospital cardiac arrest (CA) who undergo percutaneous coronary intervention (PCI) have been limited to small, mostly single-center studies. We compared patients who underwent PCI after CA included in the CathPCI Registry wi ...
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Journal ArticleAm J Cardiol · March 1, 2014
Primary percutaneous coronary intervention for ST elevation myocardial infarction (STEMI) is beneficial if performed in a timely manner. Self-transport patients with STEMI have prolonged treatment times compared with Emergency Medical Services-transported ...
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Journal ArticleAm J Cardiol · March 1, 2014
Although cocaine ingestion may cause or contribute to myocardial infarction (MI), few contemporary data are available describing cocaine-associated MI. We describe the characteristics, management, and outcomes of patients with MI and recent cocaine use fro ...
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Journal ArticleAm Heart J · March 2014
BACKGROUND: Familial hypercholesterolemia (FH) is a hereditary condition caused by various genetic mutations that lead to significantly elevated low-density lipoprotein cholesterol levels and resulting in a 20-fold increased lifetime risk for premature car ...
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Journal ArticleAm Heart J · March 2014
BACKGROUND: Patients with non-ST-elevation myocardial infarction (NSTEMI) and three-vessel or left main coronary disease (3VD/LMD) have a high risk of long-term mortality when treated with a medical management strategy (MMS) compared with revascularization ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · March 2014
BACKGROUND: Major bleeding has received increasing attention as a target for quality improvement in care of patients with acute myocardial infarction. However, little is known about variation in bleeding across hospitals and whether variation is attributab ...
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Journal ArticleAm Heart J · March 2014
BACKGROUND: Little is known about percutaneous coronary intervention (PCI) outcomes among patients presenting with an acute myocardial infarction (MI) with a history of prior PCI. Outcomes may differ depending on whether PCI is performed on a previously tr ...
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Journal ArticleAm Heart J · February 2014
BACKGROUND: Symptomatic heart failure (HF) and reduced ejection fraction (REF) are both associated with mortality, but the long-term outcomes associated with the development of HF in older non-ST-segment elevation myocardial infarction (NSTEMI) patients wi ...
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Journal ArticleJ Cardiovasc Transl Res · February 2014
The clinical trials that failed to demonstrate significant efficacy may not result in development of new therapy but contribute to better understanding of antithrombotic therapy for ischemic heart disease. Negative trials provide important messages about h ...
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Journal ArticleAm J Cardiol · January 15, 2014
The influence of the presenting electrocardiographic (ECG) findings on the treatment and outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) has not been studied in contemporary practice. We analyzed the clinical characteristi ...
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Journal ArticleAm Heart J · January 2014
OBJECTIVES: The objective of this study is to assess trends in evidence-based therapy use and short- and long-term mortality over time among older patients with non-ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND: With the prevalence of nat ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · January 2014
BACKGROUND: Prior studies have found that obese patients have paradoxically lower in-hospital mortality after non-ST-segment-elevation myocardial infarction than their normal-weight counterparts, yet whether these associations persist long term is unknown. ...
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Journal ArticleAm Heart J · December 2013
OBJECTIVES: We sought to describe real-world patterns of care in NSTEMI patients across different risk profiles for bleeding and mortality. BACKGROUND: The NCDR ACTION Registry-GWTG in-hospital mortality and major bleeding risk scores were developed to ass ...
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Journal ArticleAm Heart J · December 2013
BACKGROUND: Prior studies have observed that smokers have paradoxically favorable 1-year mortality rates after acute coronary syndromes, but it is unknown whether this association extends to long-term outcomes and to older patients. METHODS: We identified ...
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Journal ArticleAm Heart J · December 2013
BACKGROUND: In the United States as well as globally, Asians are a growing proportion of patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI), yet little is known about their longitudinal outcomes. METHODS: We linked Centers for ...
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Journal ArticleJ Am Coll Cardiol · November 19, 2013
OBJECTIVES: The aim of this report was to characterize the patients, participating centers, and measures of quality of care and outcomes for 5 NCDR (National Cardiovascular Data Registry) programs: 1) ACTION (Acute Coronary Treatment and Intervention Outco ...
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Journal ArticleAm Heart J · November 2013
BACKGROUND: Guidelines recommend consideration of cardiac biomarker measurement after elective percutaneous coronary intervention (PCI), especially with complex cases or complicated procedures. However, the long-term prognostic implications of biomarker me ...
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Journal ArticleAm Heart J · November 2013
BACKGROUND: We sought to determine the risk of readmission for bleeding and major cardiac events in stented non-ST-segment elevation myocardial infarction (NSTEMI) atrial fibrillation (AF) patients. METHODS: For this patient population, selection of an ant ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · November 2013
BACKGROUND: Cardiogenic shock is a deadly complication of an acute myocardial infarction (MI). We sought to characterize differences in patient features, treatments, and outcomes of cardiogenic shock by MI classification: ST-segment-elevation MI (STEMI) ve ...
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Journal ArticleAm J Cardiol · October 15, 2013
Despite recent therapeutic advances, significant residual risk for in-hospital mortality persists among patients admitted with acute myocardial infarction (MI). Low levels of high-density lipoprotein cholesterol (HDL-C), a known independent predictor of in ...
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Journal ArticleInt J Cardiol · October 3, 2013
BACKGROUND: Plaque rupture, acute ischemia, and necrosis in acute coronary syndromes are accompanied by concurrent pro- and anti-inflammatory cascades. Whether STEMI clinical prediction models can be improved with the addition of baseline inflammatory biom ...
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Journal ArticleCirculation · September 10, 2013
BACKGROUND: Hospital readmission rates within 30 days after acute myocardial infarction are a national performance metric. Previous data suggest that early physician follow-up after heart failure hospitalizations can reduce readmissions; whether these resu ...
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Journal ArticleCrit Pathw Cardiol · September 2013
BACKGROUND: The Society of Cardiovascular Patient Care (SCPC) accredits hospital acute coronary syndrome management. The influence of accreditation on the subset of patients diagnosed with acute myocardial infarction (AMI) is unknown. Our purpose was to de ...
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Journal ArticleCirculation · August 20, 2013
BACKGROUND: Dual antiplatelet therapy in older versus younger patients with acute coronary syndromes is understudied. Low-dose prasugrel (5 mg/d) is recommended for younger, lower-body-weight patients and elderly patients with acute coronary syndromes to m ...
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Journal ArticleLancet · August 17, 2013
BACKGROUND: Treatment with prasugrel and aspirin improves outcomes compared with clopidogrel and aspirin for patients with acute coronary syndrome who have had angiography and percutaneous coronary intervention; however, no clear benefit has been shown for ...
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Journal ArticleAm Heart J · August 2013
BACKGROUND: Cardiogenic shock complicating acute myocardial infarction (MI) in older patients is associated with a high risk of inhospital mortality; however, the long-term prognosis among these patients who survive the index hospitalization is uncertain. ...
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Journal ArticleClin Chem · August 2013
BACKGROUND: Patients with increased blood concentrations of natriuretic peptides (NPs) have poor cardiovascular outcomes after myocardial infarction (MI). The objectives of this analysis were to evaluate the utilization and the prognostic value of NP in a ...
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Journal ArticleCirc Cardiovasc Interv · August 2013
BACKGROUND: The regional variability of percutaneous coronary intervention (PCI) rates may be explained by variations in the medical treatment of stable coronary artery disease. We sought to determine whether greater regional use of antianginal medications ...
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Journal ArticleCirculation · July 23, 2013
BACKGROUND: For patients identified before hospital arrival with ST-segment-elevation myocardial infarction, bypassing the emergency department (ED) with direct transport to the catheterization laboratory may shorten reperfusion times. METHODS AND RESULTS: ...
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Journal ArticleJ Am Coll Cardiol · May 7, 2013
Relatively little attention has been focused on standardization of data exchange in clinical research studies and patient care activities. Both are usually managed locally using separate and generally incompatible data systems at individual hospitals or cl ...
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Journal ArticleAm Heart J · May 2013
With the large number of antithrombotic therapies available and under investigation for the treatment of non-ST-segment elevation acute coronary syndromes (NSTE ACS), practice guidelines now stress the importance of selecting an antithrombotic strategy acc ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · May 1, 2013
BACKGROUND: Early invasive management is recommended for patients with non-ST-segment elevation myocardial infarction (MI), but the incidence of long-term outcomes after early catheterization among older patients and the relationship of revascularization p ...
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Journal ArticleAm J Cardiol · April 15, 2013
The benefit of an invasive strategy in non-ST-segment elevation myocardial infarction (NSTEMI) was established from randomized trials that included few anemic patients. The aim of this study was to describe the characteristics, therapies, and mortality of ...
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Journal ArticleAm J Cardiol · January 15, 2013
Previous studies describing the no-reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were largely confined to single-center studies or small registries. To better characterize the incid ...
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Journal ArticleAm Heart J · January 2013
BACKGROUND: Although chronic lung disease (CLD) is common among patients with myocardial infarction (MI), little is known about the influence of CLD on patient management and outcomes following MI. METHODS: Using the National Cardiovascular Data Registry's ...
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Journal ArticleAm Heart J · January 2013
BACKGROUND: Prior studies indicate that a subset of patients diagnosed as having ST-segment elevation myocardial infarction (STEMI) will have an initial non-diagnostic electrocardiogram (ECG) during evaluation. However, the timing of diagnostic ECG changes ...
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Journal ArticleCatheter Cardiovasc Interv · December 1, 2012
OBJECTIVES: We sought to examine the contemporary use of thrombectomy during primary percutaneous coronary intervention (PCI) in the United States. BACKGROUND: Adjunctive thrombectomy during primary PCI for patients with ST-segment elevation myocardial inf ...
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Journal ArticleJ Am Coll Cardiol · November 13, 2012
OBJECTIVES: This study sought to provide a report to the public of data from the CathPCI Registry of the National Cardiovascular Data Registry. BACKGROUND: The CathPCI Registry collects data from approximately 85% of the cardiac catheterization laboratorie ...
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Journal ArticleJAMA · November 4, 2012
CONTEXT The relationship of platelet function testing measurements with outcomes in patients with acute coronary syndromes (ACS) initially managed medically without revascularization is unknown. OBJECTIVE To characterize the differences and evaluate clinic ...
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Chapter · November 1, 2012
As our understanding of the pathophysiological underpinnings of reperfusion injury has increased, many therapies directed at preventing the detrimental effects of this phenomenon have been tested. For primary PCI, this has ranged from mechanical protection ...
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Journal ArticleAm J Med · November 2012
PURPOSE: Substantial heterogeneity in hospital length of stay exists among patients admitted with non-ST-segment elevation myocardial infarction. Furthermore, little is known about the factors that impact length of stay. METHODS: We examined 39,107 non-ST- ...
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Journal ArticleJ Thromb Thrombolysis · November 2012
Pretreatment with 60 mg of prasugrel is more effective than 300 mg of clopidogrel in reducing thrombotic complications with primary percutaneous coronary intervention (PCI). We compared angiographic outcomes and platelet reactivity between treatment with 6 ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · November 2012
BACKGROUND: Left or codominant coronary arterial circulation may represent less well-balanced myocardial perfusion and thus confer worse prognosis in acute coronary syndrome, especially for culprit lesions arising from the left coronary artery. METHODS AND ...
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Journal ArticleN Engl J Med · October 4, 2012
BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, ...
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Journal ArticleAm Heart J · October 2012
BACKGROUND: An early invasive management strategy is recommended for patients with non-ST-segment elevation myocardial infarction (NSTEMI) who do not have a contraindication to cardiac catheterization (CCC). However, the frequency of CCC reporting has not ...
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Journal ArticleEur Heart J · August 2012
AIMS: Bleeding complications have been associated with short-term mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Their association with long-term outcomes is less clear. This study examines mortality associated with in- ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · July 1, 2012
BACKGROUND: The impact of polyvascular disease (peripheral arterial disease [PAD] and cerebrovascular disease [CVD]) on long-term cardiovascular outcomes among older patients with acute myocardial infarction has not been well studied. METHODS AND RESULTS: ...
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Journal ArticleJ Thromb Thrombolysis · July 2012
Coronary plaque rupture is associated with a systemic inflammatory response. The relationship between baseline N-terminal pro B-type natriuretic peptide (NT-proBNP), a prognostic marker in patients with acute coronary syndromes, and systemic inflammatory m ...
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Journal ArticleThromb Haemost · July 2012
Translational platelet function investigations performed in the percutaneous coronary intervention (PCI)-treated population receiving clopidogrel have identified high platelet reactivity to ADP (HPR) as a major risk factor for both acute as well as long-te ...
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Journal ArticleAm Heart J · July 2012
BACKGROUND: The characteristics, therapies, and outcomes of patients presenting with non-ST-segment elevation myocardial infarction, found to have significant coronary artery disease on coronary angiography, and managed without revascularization ("nonrevas ...
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Journal ArticleJ Am Coll Cardiol · May 22, 2012
OBJECTIVES: The purpose of this study was to examine temporal trends in post-percutaneous coronary intervention (PCI) bleeding among patients with elective PCI, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment el ...
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Journal ArticleAm Heart J · April 2012
BACKGROUND: Low serum high-density lipoprotein cholesterol (HDL-C) level is a potent risk factor for developing atherosclerosis, yet it is uncertain if HDL-C level at the time of non-ST-segment elevation myocardial infarction (NSTEMI) has downstream progno ...
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Journal ArticleAm Heart J · April 2012
BACKGROUND: We aimed to study the comparative safety and effectiveness of various antithrombotic treatment strategies among older adults with non-ST elevation myocardial infarction (NSTEMI) and atrial fibrillation (AF). METHODS: Using the CRUSADE registry ...
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Journal ArticleCirculation · March 20, 2012
BACKGROUND: Non-ST-segment-elevation myocardial infarction patients on home warfarin pose treatment concerns because of their potential increased risk of bleeding. Expert opinion from the American College of Cardiology/American Heart Association guidelines ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · March 1, 2012
BACKGROUND: Regional differences in the profile and prognosis of non-ST-segment elevation acute coronary syndrome (NSTE ACS) patients treated with medical management after angiography remain uncertain. METHODS AND RESULTS: Using data from the Early Glycopr ...
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Journal ArticleAm J Cardiol · February 15, 2012
Guidelines recommend urgent reperfusion for patients with new left bundle branch block (LBBB), similar to patients with ST-segment elevation myocardial infarction (STEMI). However, there are limited contemporary data comparing these 2 groups of patients. P ...
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Journal ArticleCirculation · January 24, 2012
BACKGROUND: Acute kidney injury (AKI) is a risk factor for long-term adverse outcomes, including acute myocardial infarction and death. However, the relationship between severity of AKI and in-hospital outcomes in the setting of acute myocardial infarction ...
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Journal ArticleClin Cardiol · 2012
BACKGROUND: Although peak creatine kinase-myocardial band (CK-MB) and troponin levels have been correlated with mortality among patients with acute myocardial infarction (AMI), the independent prognostic implications of these markers have not been compared ...
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Journal ArticleJ Am Coll Cardiol · December 13, 2011
OBJECTIVES: The aim of this study was to assess the impact of extreme (class III) obesity (body mass index [BMI] ≥40 kg/m(2)) on care and outcomes in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Although its prevalence is i ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · November 1, 2011
BACKGROUND: The 2007 update of the ACC/AHA guidelines for STEMI patients recommended addition of clopidogrel to aspirin regardless of reperfusion strategy, with a bolus dose in patients <75 years of age. METHODS AND RESULTS: We evaluated use and dose of ea ...
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Journal ArticleAm Heart J · November 2011
OBJECTIVES: We sought to develop a long-term mortality risk prediction model and a simplified risk score for use in older patients with non-ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND: Limited data are available regarding long-term mort ...
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Journal ArticleJAMA · October 5, 2011
CONTEXT: Patients undergoing elective percutaneous coronary intervention (PCI) are generally observed overnight in the hospital. The association between same-day discharge of older patients and death or readmission is unclear. OBJECTIVE: To evaluate the pr ...
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Journal ArticleJACC Cardiovasc Interv · September 2011
OBJECTIVES: This study sought to evaluate the characteristics, therapies, and outcomes of patients with chronic kidney disease (CKD) presenting with non-ST-segment elevation myocardial infarction (NSTEMI) and managed with percutaneous coronary intervention ...
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Journal ArticleJACC Cardiovasc Interv · August 2011
OBJECTIVES: This study examined a large registry to determine the frequency, predictors, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass graft surgery (CABG). ...
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Journal ArticleCirculation · July 12, 2011
BACKGROUND: Activation of emergency medical services (EMS) is critical for the early triage and treatment of patients experiencing ST-segment-elevation myocardial infarction, yet data regarding EMS use and its association with subsequent clinical care are ...
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Journal ArticleJAMA · June 22, 2011
CONTEXT: Patients with ST-elevation myocardial infarction (STEMI) requiring interhospital transfer for primary percutaneous coronary intervention (PCI) often have prolonged overall door-to-balloon (DTB) times from first hospital presentation to second hosp ...
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Journal ArticleBMJ · June 17, 2011
OBJECTIVE: To evaluate efficacy and safety outcomes in patients in the PLATelet inhibition and patient Outcomes (PLATO) trial who at randomisation were planned for a non-invasive treatment strategy. DESIGN: Pre-specified analysis of pre-randomisation defin ...
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Journal ArticleAm J Cardiol · May 15, 2011
Patients with previous stroke are at high-risk for myocardial infarction (MI). Concern regarding increased risk of bleeding or recurrent stroke in this patient population might alter therapeutic decisions. Data were collected from 281 hospitals in the Unit ...
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Journal ArticleAm Heart J · May 2011
BACKGROUND: Although β-blockers (BBs) reduce long-term mortality in patients after myocardial infarction (MI), data regarding acute usage are conflicting. METHODS: We examined acute (≤24 hours) BB use in 34,661 patients with ST-elevation MI (STEMI) and non ...
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Journal ArticleAm J Cardiol · April 15, 2011
Bleeding, a common complication of acute myocardial infarction (AMI) treatment, is associated with worse outcomes. A contemporary model for major bleeding associated with AMI treatment can stratify patients at elevated risk for bleeding and is needed to ri ...
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Journal ArticleAm Heart J · April 2011
BACKGROUND: Patients with diabetes have increased in-hospital mortality following acute myocardial infarction (AMI), with studies suggesting higher risk with both hypoglycemia and hyperglycemia. We assessed whether a J-shaped relation exists between hemogl ...
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Journal ArticleAm Heart J · April 2011
BACKGROUND: A higher loading dose of clopidogrel achieves a more rapid and consistent degree of platelet inhibition than standard dosing, although the clinical benefit of higher doses has not been clearly established. The use of the different doses in clin ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · March 2011
BACKGROUND: In the Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) study, patients assigned enoxaparin or unfractionated heparin (UFH) were treated with alternative anticoagulant therapy a ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · January 1, 2011
BACKGROUND: Efforts to improve quality of care for patients with acute myocardial infarction (AMI) are a national priority. To date, there have been few studies that have prospectively evaluated hospital quality improvement (QI) interventions. METHODS AND ...
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Journal ArticleAm Heart J · January 2011
BACKGROUND: accurate risk adjustment is needed to guide quality improvement initiatives and research to improve care of patients with acute myocardial infarction (MI). We developed and validated a model to predict the risk of in-hospital mortality for cont ...
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Journal ArticleAm Heart J · January 2011
BACKGROUND: national initiatives have reduced door-to-balloon (DTB) times for direct-arrival ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). However, STEMI patients requiring interhos ...
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Journal ArticleJACC Cardiovasc Interv · January 2011
OBJECTIVES: This study sought to develop a tool for predicting an individual's risk of mortality following rescue percutaneous coronary intervention (PCI). BACKGROUND: Although fibrinolytic therapy is appropriate and improves survival for certain ST-segmen ...
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Journal ArticleAm Heart J · December 2010
BACKGROUND: Glycoprotein (GP) IIb/IIIa inhibitors can improve outcomes in patients with non-ST-segment elevation acute coronary syndromes but raise the risk of bleeding, particularly if dosed in excess. The impact of GP IIb/IIIa dosing feedback on safety a ...
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Journal ArticleAm Heart J · December 2010
BACKGROUND: Current American College of Cardiology/American Heart Association guidelines recommend initiation or intensification of statin therapy to achieve low-density lipoprotein cholesterol (LDL-C) goals after an acute coronary syndrome (ACS), yet litt ...
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Journal ArticleArch Intern Med · November 8, 2010
BACKGROUND: Secular trends and factors associated with delay time from symptom onset to hospital presentation are known for patients with ST-segment elevation myocardial infarction (STEMI) but are less well-described for non-STEMI. METHODS: We studied 104 ...
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Journal ArticleHeart · November 2010
AIMS: The NCDR ACTION Registry-GWTG collects detailed in-hospital clinical, process-of-care and outcomes data for patients admitted with acute myocardial infarction (AMI) in the USA. The registry is a national AMI surveillance system that contributes to th ...
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Journal ArticleAm Heart J · November 2010
BACKGROUND: Despite the 2000 and 2007 redefinition of myocardial infarction (MI), patients who are troponin (Tn) positive ([+]) but MB negative ([-]) may not be considered to have MI, particularly in the absence of known coronary disease (prior MI or revas ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · November 2010
BACKGROUND: Secondary prevention therapies are indicated for patients with coronary artery disease (CAD). However, patients with nonobstructive CAD may be less likely to receive these therapies compared with patients with obstructive CAD. Therefore, we com ...
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Journal ArticleJACC Cardiovasc Interv · October 2010
OBJECTIVES: We examined a large registry to determine the frequency and factors associated with drug-eluting stents (DES) use in saphenous vein graft (SVG) in contemporary practice. BACKGROUND: Prospective trials comparing DES with bare-metal stents in SVG ...
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Journal ArticleAm Heart J · September 2010
BACKGROUND: Patients with non-ST-segment elevation myocardial infarction (NSTEMI) are frequently transferred to tertiary hospitals for angiography and/or revascularization from hospitals lacking such capabilities. Given that patients who undergo invasive c ...
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Journal ArticleJ Clin Oncol · July 20, 2010
PURPOSE: An independent Adjuvant Cardiac Review and Evaluation Committee (ACREC) systematically reviewed cases of symptomatic heart failure events to uniformly define the cardiac event rate across two large trials (National Surgical Adjuvant Breast and Bow ...
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Journal ArticleAm Heart J · July 2010
Practice guidelines recommend dual antiplatelet therapy with aspirin and clopidogrel for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) regardless of in-hospital management strategy. Prasugrel-a thienopyridine adenosine diphosph ...
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Journal ArticleAm Heart J · July 2010
Despite current dual-antiplatelet therapy with aspirin and clopidogrel, adverse clinical events continue to occur during and after percutaneous coronary intervention (PCI). The failure of clopidogrel to provide optimal protection may be related to delayed ...
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Journal ArticleJACC Cardiovasc Interv · June 2010
OBJECTIVES: The aim of this study was to examine the use of and outcomes associated with antithrombotic strategies in patients with non-ST-segment elevation myocardial infarction (NSTEMI) who undergo percutaneous coronary intervention (PCI). BACKGROUND: A ...
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Journal ArticleAm Heart J · June 2010
BACKGROUND: In contemporary practice, the degree to which fibrinolytic therapy is administered in a timely fashion for ST-segment elevation myocardial infarction (STEMI) and its association with outcomes is not well-known. Our objective was to assess the p ...
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Journal ArticleJ Am Coll Cardiol · May 4, 2010
OBJECTIVES: We sought to create contemporary models for predicting mortality risk following percutaneous coronary intervention (PCI). BACKGROUND: There is a need to identify PCI risk factors and accurately quantify procedural risks to facilitate comparativ ...
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Journal ArticleAm Heart J · May 2010
BACKGROUND: Prompt reperfusion for patients with ST-segment elevation myocardial infarction (STEMI) is a class I guideline recommendation and has been shown to reduce mortality. However, many STEMI patients in contemporary practice still do not receive any ...
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Journal ArticleJACC Cardiovasc Interv · April 2010
OBJECTIVES: The aim of this study was to examine timing of in-hospital coronary artery bypass graft surgery (CABG) for non-ST-segment elevation myocardial infarction (NSTEMI) patients. BACKGROUND: Although practice guidelines recommend delaying CABG for a ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · March 2010
BACKGROUND: Hospitals use patient satisfaction surveys to assess their quality of care. A key question is whether these data provide valid information about the medically related quality of hospital care. The objective of this study was to determine whethe ...
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Journal ArticleEur Heart J · March 2010
AIMS: To evaluate the relationship between presenting heart rate (HR) and in-hospital events in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). METHODS AND RESULTS: We evaluated 139 194 patients with NSTE-ACS in the CRUSADE qual ...
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Journal ArticleClin Cardiol · March 2010
BACKGROUND: Results from the Superior Yield of the New Strategy of Enoxaparin, Revascularization, and Glycoprotein IIb/IIIa Inhibitors (SYNERGY) trial showed that the low-molecular-weight heparin (LMWH) enoxaparin was non-inferior compared with unfractiona ...
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Journal ArticleClin Cardiol · February 2010
BACKGROUND: Women are at greater risk for worse outcomes associated with acute coronary syndrome (ACS) than are men. One explanation may be that they tend to be treated less aggressively than men even when more aggressive treatment is warranted. The purpos ...
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Journal ArticleCirculation · January 26, 2010
BACKGROUND: Chronic kidney disease (CKD) is a risk factor for myocardial infarction (MI) and death. Our goal was to characterize the association between CKD severity and short-term outcomes and the use of in-hospital evidence-based therapies among patients ...
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Journal ArticleAm J Cardiol · December 15, 2009
The currently available sudden cardiac death (SCD) risk prediction tools fail to identify most at-risk patients and cannot delineate a specific patient's SCD risk. We sought to develop a tool to improve the risk stratification of patients with coronary art ...
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Journal ArticleJAMA · December 9, 2009
CONTEXT: The US Food and Drug Administration guides clinicians through drug labeling of medications that are contraindicated or not recommended for use in specific patient groups. Little is known about the use of such medications and their effects on outco ...
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Journal ArticleAm Heart J · December 2009
BACKGROUND: Inhibition of the P2Y12 ADP-receptor with oral antiplatelet agents given to patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is associated with improved outcomes, but this strat ...
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Journal ArticleClin Cardiol · December 2009
BACKGROUND: This article will describe the impact of prehospital electrocardiogram (ECG) use on emergency department (ED) processes of care for non-ST-segment elevation myocardial infarction (NSTEMI) patients and assess the characteristics associated with ...
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Journal ArticleAm J Cardiol · November 15, 2009
We evaluated the reported contraindications to early beta-blocker use and associated mortality within and across patient age groups. Contraindications to early beta-blocker use were evaluated in patients with non-ST-elevation acute coronary syndrome in the ...
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Journal ArticleAm J Cardiol · November 15, 2009
The effect of nonstandardized creatine kinase (CK)-MB assays on the assessment of myocardial infarction (MI) end points in multicenter international trials has not been evaluated. We compared the site-reported and corresponding core laboratory CK-MB measur ...
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Journal ArticleAm Heart J · November 2009
BACKGROUND: Prior studies have demonstrated differences in adherence to non-ST-segment elevation acute coronary syndromes (NSTE ACS) guidelines-recommended therapies among patients managed conservatively without cardiac catheterization compared with those ...
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Journal ArticleJ Am Geriatr Soc · November 2009
OBJECTIVES: To describe the persistent use of evidence-based cardiovascular medications (EBCMs) 3 months after discharge from an acute coronary syndrome (ACS) event and patient-reported reasons for nonpersistence across age groups. DESIGN: Medication Appli ...
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Journal ArticleAm Heart J · October 2009
BACKGROUND: Women with non-ST-segment elevation myocardial infarction (NSTEMI) who undergo coronary angiography have no obstructive coronary lesions more often than men. Sex-specific characteristics and outcomes of patients without obstructive coronary art ...
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Journal ArticleClin Cardiol · September 2009
BACKGROUND: Hypercholesterolemia is a risk factor for coronary artery disease, yet is associated with lower risk of adverse outcomes in patients with acute coronary syndromes (ACS). HYPOTHESIS: We explored this paradox in 84,429 patients with non-ST-segmen ...
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Journal ArticleClin Cardiol · September 2009
BACKGROUND: Point-of-care (POC) testing may expedite the care of emergency department (ED) patients suspected of having acute coronary syndromes (ACS). We evaluated the use patterns of cardiac bedside markers or POC testing for troponin in patients with no ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · September 2009
BACKGROUND: The risks of late stent thrombosis with drug-eluting stents (DES) were intensely debated after the presentation of a number of studies highlighting this issue in September 2006. We evaluated trends in the use of DES for patients with non-ST-ele ...
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Journal ArticleClin Cardiol · September 2009
BACKGROUND: Acute treatment is associated with improved in-hospital outcomes for patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS). HYPOTHESIS: Patients who receive appropriate acute treatment are more likely to receive guideline-re ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · September 2009
BACKGROUND: There is a recognized need for a national unified registry to track presenting features, care, and outcomes for patients with acute myocardial infarction. To address this need, the American Heart Association's Get With the Guidelines-Coronary A ...
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Journal ArticleJAMA · August 26, 2009
CONTEXT: Conflicting information exists about whether sex differences modulate short-term mortality following acute coronary syndromes (ACS). OBJECTIVES: To investigate the relationship between sex and 30-day mortality in ACS, and to determine whether this ...
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Journal ArticleAm J Cardiol · August 15, 2009
Guidelines support percutaneous coronary intervention (PCI) of the noninfarct-related artery during primary PCI for ST-segment elevation myocardial infarction (STEMI) in patients with hemodynamic compromise; however, in patients without hemodynamic comprom ...
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Journal ArticleAm Heart J · August 2009
BACKGROUND: The long-term benefits of coronary revascularization are proportional to the severity of underlying coronary artery disease (CAD). We sought to identify patients with a greater probability of severe CAD to target those who could receive the gre ...
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Journal ArticleAm J Cardiol · August 1, 2009
Stroke is a serious complication of percutaneous coronary intervention (PCI). Clinical characteristics associated with this complication have not been well defined. Data were analyzed from the National Cardiovascular Data Registry. All patients undergoing ...
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Journal ArticleAm J Cardiol · July 15, 2009
Use of evidence-based medicine (EBM) improves outcomes after acute coronary syndromes (ACS), yet patients often discontinue prescribed therapies after discharge. Although such discontinuation is well documented, patients' reasons for medication discontinua ...
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Journal ArticleAnn Emerg Med · July 2009
STUDY OBJECTIVE: Since 2003, the Society of Chest Pain Centers (SCPC) has provided hospital accreditation for acute coronary syndrome care processes. Our objective is to evaluate the association between SCPC accreditation and adherence to the American Coll ...
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Journal ArticleCirculation · June 23, 2009
BACKGROUND: There are limited contemporary data comparing long-term outcomes after cardiac catheterization for ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). METHODS AND RESULTS: We studied patients undergoing cardiac catheteriz ...
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Journal ArticlePharmacotherapy · June 2009
STUDY OBJECTIVE: To evaluate how enoxaparin is dosed in contemporary clinical practice as a function of patients' total body weight (TBW) and body mass index (BMI), and to determine any association between dose and major bleeding. DESIGN: Retrospective coh ...
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Journal ArticleCirc Cardiovasc Interv · June 2009
BACKGROUND: Bleeding in patients undergoing percutaneous coronary intervention (PCI) is associated with increased morbidity, mortality, length of hospitalization, and cost. We identified baseline clinical characteristics associated with bleeding complicati ...
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Journal ArticleCirculation · May 12, 2009
BACKGROUND: Prior studies examining thrombocytopenia among patients with acute coronary syndromes (ACS) evaluated highly selected patients in a clinical trial setting using varying definitions of thrombocytopenia. The incidence, severity, and prognostic si ...
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Journal ArticleCirc Cardiovasc Qual Outcomes · May 2009
BACKGROUND: Troponin elevation above the upper limit of normal (ULN) is diagnostic of myocardial infarction, but interpretation of "gray-zone" troponin elevations (1 to 1.5x ULN) remains uncertain. Using the CRUSADE database, we explored relationships betw ...
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Journal ArticleEur Heart J · May 2009
AIMS: The presence of peripheral arterial disease (PAD) or cerebrovascular disease (CVD) is associated with higher likelihood of significant coronary artery disease (CAD). We sought to assess the prevalence of PAD, CVD, prior CAD, or pre-existent disease i ...
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Journal ArticleCirculation · April 14, 2009
BACKGROUND: Treatments for non-ST-segment-elevation myocardial infarction (NSTEMI) reduce ischemic events but increase bleeding. Baseline prediction of bleeding risk can complement ischemic risk prediction for optimization of NSTEMI care; however, existing ...
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Journal ArticleArterioscler Thromb Vasc Biol · April 2009
Platelet G protein-coupled receptors (GPCRs) initiate and reinforce platelet activation and thrombus formation. The clinical utility of antagonists of the P2Y(12) receptor for ADP suggests that other GPCRs and their intracellular signaling pathways may rep ...
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Journal ArticleAm Heart J · April 2009
BACKGROUND: Because acute occlusion of coronary arteries supplying the inferolateral myocardium frequently eludes standard 12-lead electrocardiogram (ECG) diagnosis, these patients may present as non-ST-segment elevation acute coronary syndromes (NSTE-ACS) ...
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Journal ArticleAm J Cardiol · March 15, 2009
Age and chronic kidney disease are major risk factors for poor cardiovascular outcome; however, renal function is often estimated on the basis of serum creatinine levels, and advanced renal impairment may be hidden behind near normal creatinine levels. We ...
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Journal ArticleAm Heart J · March 2009
BACKGROUND: The relationship between systolic blood pressure (BP) and the risk of cardiovascular events is complex. In patients with chronic coronary artery disease, a J-shaped relationship has been shown, such that there is an increased risk of events bot ...
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Journal ArticleCrit Pathw Cardiol · March 2009
Evidence-based guidelines call for advanced and definitive therapy for patients with non-ST-elevation myocardial infarction (NSTEMI). It is not known whether these guidelines are follow more diligently when patients arrive in the ED during regular hours, d ...
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Journal ArticleAm J Kidney Dis · March 2009
BACKGROUND: Chronic kidney disease (CKD) is associated with an increased risk of cardiac events and death; however, underuse of guideline-recommended therapies is widespread. The extent to which hospital performance affects the care of patients with CKD an ...
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Journal ArticleCirc Cardiovasc Interv · February 2009
BACKGROUND: Temporal trends and contemporary data characterizing the impact of patient age on in-hospital outcomes of percutaneous coronary interventions are lacking. We sought to determine the importance of age by assessing the in-hospital mortality of st ...
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Journal ArticleJ Am Coll Cardiol · January 13, 2009
OBJECTIVES: This study sought to determine the association of pre-hospital electrocardiograms (ECGs) and the timing of reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Pre-hospital ECGs have been recomme ...
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Journal ArticleJACC Cardiovasc Interv · January 2009
OBJECTIVES: We sought to evaluate the impact of post-primary percutaneous coronary intervention (PCI) Thrombolysis In Myocardial Infarction (TIMI) flow grades in the infarct-related artery (IRA) in patients with ST-segment elevation myocardial infarction ( ...
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Journal ArticleAm Heart J · January 2009
BACKGROUND: Although prior studies have demonstrated disparities in the management and outcomes of women with acute coronary syndrome (ACS), there are limited large-scale contemporary data on gender differences in post-intervention outcomes in this populat ...
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Journal ArticleAm J Cardiol · November 15, 2008
We sought to determine the usage patterns and impact of upstream glycoprotein IIb/IIIa inhibitor and clopidogrel in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). We studied tre ...
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Journal ArticleEur Heart J · October 2008
AIMS: The patterns and prognostic significance of low high-density lipoprotein (HDL) cholesterol levels have not been well characterized. We sought to determine the prevalence and prognostic significance of low HDL cholesterol levels in patients with non-S ...
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Journal ArticleJ Am Coll Cardiol · September 16, 2008
OBJECTIVES: Because excess adiposity is one of the most important determinants of adipokines and inflammatory factors associated with coronary plaque rupture, we hypothesized that obesity was associated with myocardial infarction at earlier ages. BACKGROUN ...
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Journal ArticleAm J Med · September 2008
BACKGROUND: Although the use of heparin with fibrinolytics is associated with more rapid ST-segment resolution and increased infarct-related artery patency among patients with ST-segment elevation myocardial infarction (STEMI), its associated increase in b ...
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Journal ArticleAm Heart J · September 2008
BACKGROUND: Although current guidelines recommend early initiation of clopidogrel in patients with non-ST-segment elevation myocardial infarction (NSTEMI), the degree to which it has been adopted in clinical practice remains unclear. We sought to determine ...
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Journal ArticleArch Intern Med · August 11, 2008
BACKGROUND: Patient medical records are important means of communication among health care providers. Limited evaluation has been performed of the quality of the medical records or its association with health care processes or outcomes. METHODS: We perform ...
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Journal ArticleAm Heart J · August 2008
BACKGROUND: Unfractionated heparin (UFH) is a mainstay of treatment for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), but the practice of weight-adjusted bolus and infusion dosing has not been carefully evaluated. METHODS: Usi ...
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Journal ArticleJACC Cardiovasc Interv · August 2008
OBJECTIVES: Our goal was to compare trends in the prevalence and outcomes of the radial and femoral approaches to percutaneous coronary intervention (PCI) in contemporary clinical practice. BACKGROUND: There are few current data on the use and outcomes of ...
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Journal ArticleJACC Cardiovasc Interv · August 2008
OBJECTIVES: We sought to characterize the utilization and impact of a conservative medical management strategy for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) and significant coronary artery disease on early angiography. BACK ...
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Journal ArticleCurr Cardiol Rep · July 2008
The CRUSADE National Quality Improvement Initiative was created to track national care patterns, facilitate process improvement, and improve patient outcomes among patients with acute coronary syndromes (ACS). CRUSADE found that patients in community pract ...
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Journal ArticleAm Heart J · July 2008
BACKGROUND: Practice guidelines for non-ST-segment elevation acute coronary syndromes (NSTE ACS) recommend early invasive management (cardiac catheterization and revascularization within 48 hours of hospital presentation) for high-risk patients, but interh ...
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Journal ArticlePostgrad Med · July 2008
ST-segment elevation myocardial infarction (STEMI) is a serious manifestation of atherothrombosis. Platelets play an important role in the pathogenesis of atherothrombosis, and the use of antiplatelet agents is associated with substantial improvements in c ...
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Journal ArticleAm Heart J · June 2008
OBJECTIVES: To describe the association between transfusion and outcomes as a function of nadir hematocrit (HCT) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). BACKGROUND: The adverse outcomes associated with transfusion in ...
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Journal ArticleAm J Cardiol · May 15, 2008
The periprocedural management, bleeding risks, and outcomes of patients taking warfarin previous to percutaneous coronary intervention (PCI) have not been well characterized. All patients undergoing PCI in the National Cardiovascular Data Registry from Jan ...
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Journal ArticleEur Heart J · May 2008
AIMS: To examine treatment patterns and outcomes of patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) receiving long-term warfarin anticoagulation. METHODS AND RESULTS: We examined acute medication and invasive cardiac procedure use ...
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Journal ArticleJ Emerg Med · May 2008
The efficacy of fibrinolytics in the treatment of ST-elevation myocardial infarction is directly related to the time of administration, with the first 2 h after symptom onset seen as a critical period for greatest improvement in cardiovascular parameters a ...
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Journal ArticleArch Intern Med · March 24, 2008
BACKGROUND: Barriers to institutions participating in clinical trials include concerns about harms and costs. However, we hypothesized that patients treated at hospitals participating in trials would have better outcomes than patients treated at nonpartici ...
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Journal ArticleJ Am Coll Cardiol · March 11, 2008
OBJECTIVES: Our purpose was to compare formulae for estimating glomerular filtration rate (GFR) in non-ST-segment elevation acute coronary syndromes (NSTE ACS) patients. BACKGROUND: Assessment of GFR is important for antithrombotic dose adjustment in NSTE ...
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Journal ArticleAm Heart J · March 2008
Despite emphasis on the use of invasive management strategies for patients with non-ST-elevation acute coronary syndromes (NSTE ACS) in recent practice guidelines, 27% to 56% of NSTE ACS patients do not undergo diagnostic angiography, and a further 45% to ...
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Journal ArticleClin Cardiol · March 2008
BACKGROUND: The prognostic value of cardiac troponins (cTn) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) and chronic kidney disease (CKD) is debated. HYPOTHESIS: We tested the performance of cTnI and cTnT for risk stratific ...
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Journal ArticleCirculation · February 19, 2008
BACKGROUND: KAI-9803, a delta-protein kinase C inhibitor, has been shown to ameliorate injury associated with ischemia and reperfusion in animal models of acute myocardial infarction (MI). METHODS AND RESULTS: Direct Inhibition of delta-Protein Kinase C En ...
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Journal ArticleAm J Cardiol · February 1, 2008
Drug-eluting stents (DESs) are used in >80% of percutaneous coronary intervention (PCI) procedures; however, up to 2/3 are used for off-label indications. Factors associated with DES use in patients with ST-elevation myocardial infarction (STEMI) are not k ...
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Journal ArticleAm Heart J · February 2008
BACKGROUND: Patients experiencing acute coronary syndromes (ACS) with high-risk features frequently undergo percutaneous coronary intervention (PCI) with stent placement, prompting the requisite administration of aspirin and clopidogrel. The current manage ...
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Journal ArticleJ Cardiovasc Nurs · 2008
The American College of Cardiology and American Heart Association publishes evidence-based guideline recommendations, yet the degree to which these guidelines are followed and the association between hospital guideline adherence and patient outcomes are un ...
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Journal ArticleAm Heart J · January 2008
BACKGROUND: Multivessel (MV) coronary artery disease (CAD) frequently exists in patients presenting with non-ST-elevation (NSTE) acute coronary syndromes (ACSs). Although an early invasive strategy improves outcome in these patients, there are limited data ...
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Journal ArticleAm J Cardiol · December 15, 2007
Elevated B-type natriuretic peptide (BNP) levels are associated with increased risk for mortality in patients with non-ST-segment-elevation (NSTE) acute coronary syndromes (ACS). However, the optimal use of BNP measurement for the risk stratification of th ...
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Journal ArticleAm Heart J · December 2007
BACKGROUND: Hospitals are under increasing pressure to improve their quality of care. However, a key question remains: how can hospitals best design and implement successful quality improvement (QI) programs? Hospitals currently employ a variety of QI init ...
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Journal ArticleCan J Cardiol · November 2007
BACKGROUND: Practice guidelines support an early invasive strategy in patients with non-ST segment elevation acute coronary syndromes, particularly in those at higher risk. OBJECTIVES: To compare North American rates of invasive cardiac procedure use strat ...
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Journal ArticleAnn Emerg Med · November 2007
STUDY OBJECTIVE: We evaluate the association of emergency department (ED) length of stay with use of guideline-recommended therapies for acute treatments and clinical outcomes. Prolonged ED stays often reflect ED crowding or limited hospital capacity. We h ...
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Journal ArticleAcad Emerg Med · November 2007
Translating research results into routine clinical practice remains difficult. Guidelines, such as the 2002 American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Unstable Angina and non-ST-segment elevatio ...
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Journal ArticleJ Am Coll Cardiol · October 9, 2007
OBJECTIVES: We sought to determine whether for-profit status influenced hospitals' care or outcomes among non-ST-segment elevation myocardial infarction (NSTEMI) patients. BACKGROUND: While for-profit hospitals potentially have financial incentives to sele ...
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Journal ArticleCirculation · September 4, 2007
BACKGROUND: Since the broad dissemination of practice guidelines, the association of specialty care with the treatment of patients with acute coronary syndromes has not been studied. METHODS AND RESULTS: We evaluated 55 994 patients with non-ST-segment ele ...
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Journal ArticleAm J Cardiol · August 1, 2007
It has been suggested that Asians may respond differently to antithrombotic therapy, but contemporary management and outcomes of non-ST-segment elevation (NSTE) acute coronary syndromes (ACSs) in Asian patients have not been well characterized. Using data ...
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Journal ArticleAm J Med · August 2007
PURPOSE: Early use of beta-blockers is a quality indicator for the treatment of patients with non-ST-segment elevation myocardial infarction (NSTEMI), despite limited data from randomized clinical trials in this population. We sought to determine the impac ...
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Journal ArticleArch Intern Med · July 23, 2007
BACKGROUND: The efficacy of enoxaparin sodium in non-ST-segment elevation acute coronary syndromes is well established; however, concerns remain regarding bleeding risk. The extent to which bleeding risk is attributable to excess dosing of enoxaparin is un ...
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Journal ArticleJAMA · June 6, 2007
CONTEXT: Pay for performance has been promoted as a tool for improving quality of care. In 2003, the Centers for Medicare & Medicaid Services (CMS) launched the largest pay-for-performance pilot project to date in the United States, including indicators fo ...
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Journal ArticleAm J Cardiol · June 1, 2007
Recent studies have suggested that low-dose aspirin has preserved benefit with less bleeding compared with standard-dose aspirin when given with or without clopidogrel in patients with high-risk non-ST-segment elevation acute coronary syndromes (NSTE ACSs) ...
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Journal ArticleAm J Cardiol · May 15, 2007
Although glycoprotein (GP) IIb/IIIa inhibitors are recommended for patients with unstable angina and non-ST-segment elevation myocardial infarction who undergo percutaneous coronary intervention (PCI), the American College of Cardiology/American Heart Asso ...
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Journal ArticleAm J Cardiol · May 15, 2007
Previous studies of non-ST-segment elevation acute coronary syndromes (NSTE ACSs) complicated by heart failure (HF) have focused primarily on patients with left ventricular systolic dysfunction defined by an ejection fraction (EF) <40%. Little is known abo ...
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Journal ArticleJ Am Coll Cardiol · May 1, 2007
OBJECTIVES: The goal of this work was to explore the treatment and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) age > or =90 years. BACKGROUND: The elderly are often excluded from clinical trials of NSTE-ACS and ar ...
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Journal ArticleAm J Cardiol · May 1, 2007
Since the introduction of drug-eluting stents (DESs), patterns of revascularization strategies for patients with non-ST-segment elevation acute coronary syndromes have not been assessed. We studied 82,924 patients from the CRUSADE Initiative who presented ...
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Journal ArticleAm Heart J · April 2007
BACKGROUND: Although documented traditional cardiovascular risk factors (hypertension, diabetes, smoking, and dyslipidemia) increase the risk of developing coronary artery disease, their influence on the treatments and outcomes of patients with non-ST-segm ...
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Journal ArticleEur Heart J · February 2007
AIMS: To assess the significance of creatine kinase (CK)-MB elevations in outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) who have undergone coronary artery bypass grafting (CABG) surgery. METHODS AND RESULTS: This an ...
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Journal ArticleAm J Med · January 2007
PURPOSE: Although adherence to guidelines recommendations is assumed to be more difficult for nonacademic community hospitals, patterns of adherence have not been evaluated by hospital type. We sought to identify hospital characteristics associated with hi ...
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Journal ArticleCardiovasc Drug Rev · 2007
Guidelines recommend that dual antiplatelet therapy using aspirin and clopidogrel should be administered to the majority of patients with acute coronary syndromes, including those undergoing percutaneous coronary intervention (PCI). However, the results of ...
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Journal ArticleAm J Cardiol · December 18, 2006
The Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) initiative is a prospective, rapid-cycle quality-improve ...
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Journal ArticleAnn Intern Med · November 21, 2006
BACKGROUND: The impact of insurance coverage on the care of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) is unclear. OBJECTIVE: To compare NSTE ACS care patterns by insurance type. DESIGN: Comparison of Medicaid patients young ...
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Journal ArticleAm J Cardiol · November 1, 2006
We evaluated temporal trends in the use of early (<48 hours) catheterization in patients with non-ST-segment elevation acute coronary syndromes with respect to baseline risk features since publication of the American College of Cardiology/American Heart As ...
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Journal ArticleArch Intern Med · October 9, 2006
BACKGROUND: The extent to which national health quality improvement initiatives have altered reported treatment gaps among patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) is unknown. We sought to determine recent trends in adhere ...
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Journal ArticleAm Heart J · October 2006
BACKGROUND: We sought to assess the influence of emergency department (ED) structure and care processes on adherence to practice guidelines for the treatment of patients with non-ST-segment elevation acute coronary syndromes. METHODS: We surveyed emergency ...
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Journal ArticleAm Heart J · October 2006
BACKGROUND: Unlike ST-segment elevation myocardial infarction, the degree of stenosis and physiology of ischemia varies in patients with non-ST-segment elevation myocardial infarction (NSTEMI). The prevalence, predictors, and outcomes of patients with NSTE ...
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Journal ArticleAm Heart J · October 2006
Recent developments have provided a unique opportunity for the organization of regional ST-elevation myocardial infarction (STEMI) receiving center (SRC) networks. Because cumulative evidence has demonstrated that rapid primary percutaneous coronary interv ...
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Journal ArticleCirculation · September 26, 2006
BACKGROUND: Glycoprotein (GP) IIb/IIIa inhibitors are beneficial in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS); their safe use in women, however, remains a concern. The contribution of dosing to the observed sex-related diff ...
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Journal ArticleAm J Cardiol · September 1, 2006
In the case of non-ST-segment elevation acute coronary syndromes (NSTE-ACSs), the acute use of certain antiplatelet agents is complicated by concerns about perioperative bleeding risks in patients requiring coronary artery bypass grafting (CABG) during the ...
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Journal ArticleJ Am Coll Cardiol · July 18, 2006
OBJECTIVES: We sought to characterize patterns of clopidogrel use before coronary artery bypass grafting (CABG) and examine the drug's impact on risks for postoperative transfusions among patients with non-ST-segment elevation acute coronary syndromes (NST ...
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Journal ArticleAm J Med · July 2006
PURPOSE: An analysis of reginal variation across the United States in the treatment and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) has not been previously performed. SUBJECTS AND METHODS: We assessed contemporary ...
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Journal ArticleAm Heart J · July 2006
BACKGROUND: Data regarding the management of non-ST-segment elevation acute coronary syndromes (NSTE ACS) in Hispanic patients, the largest and fastest-growing minority in the United States, are scarce. METHODS: We sought to describe the clinical character ...
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Journal ArticleAm Heart J · July 2006
BACKGROUND: Although obesity is a known risk factor for coronary artery disease, its impact on the presentation, treatment, and outcome of patients with acute coronary syndromes (ACS) has not been well studied. METHODS: Using data from the CRUSADE Initiati ...
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Journal ArticleAm J Cardiol · June 15, 2006
The presence of congestive heart failure (CHF) has been associated with treatment disparities and worse outcomes in patients with ST-segment elevation myocardial infarction, but the incidence and effect of CHF in patients with non-ST-segment elevation acut ...
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Journal ArticleJ Thromb Thrombolysis · June 2006
BACKGROUND: Both heparin and glycoprotein (GP) IIb/IIIa inhibitor therapy and early invasive management strategies are recommended by the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for the treatment of patients with no ...
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Journal ArticleAm Heart J · June 2006
BACKGROUND: Practice guidelines for patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS) recommend targeting evidence-based therapies for the highest-risk patients. We characterized guideline adherence for NSTE ACS by risk status. M ...
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Journal ArticleJAMA · April 26, 2006
CONTEXT: Selected care processes are increasingly being used to measure hospital quality; however, data regarding the association between hospital process performance and outcomes are limited. OBJECTIVES: To evaluate contemporary care practices consistent ...
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Journal ArticleArch Intern Med · April 10, 2006
BACKGROUND: Clopidogrel added to aspirin improved outcomes after hospitalization in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) in the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial, regardless of in- ...
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Journal ArticleAm J Med · March 2006
PURPOSE: Chronic kidney disease has been linked to high mortality rates in patients with ST-segment elevation myocardial infarction but has not been well described for patients with non-ST-segment elevation acute coronary syndromes. We examined the treatme ...
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Journal ArticleAm J Cardiol · February 15, 2006
We sought to determine the frequency of electrocardiographic (ECG) acquisition within 10 minutes of hospital arrival, factors associated with delayed ECG acquisition, and any relation among delayed ECG acquisition, treatment patterns, and clinical outcomes ...
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Journal ArticleJ Am Coll Cardiol · January 17, 2006
OBJECTIVES: We sought to evaluate the association between discordant cardiac marker results and in-hospital mortality and treatment patterns in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). BACKGROUND: Creatine kinase-MB (CK-M ...
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Journal ArticleAm Heart J · January 2006
BACKGROUND: The degree to which elevated creatine kinase (CK)-MB in the presence of normal CK is predictive of outcome is not well understood despite having been studied for decades. This analysis examined whether normal CK with elevated CK-MB in patients ...
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Journal ArticleDiabetes Care · January 2006
OBJECTIVE: The objective of this study was to characterize treatment patterns among patients with diabetes presenting with non-ST-segment elevation (NSTE) acute coronary syndromes (ACSs). RESEARCH DESIGN AND METHODS: We compared adherence to treatment reco ...
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Journal ArticleJAMA · December 28, 2005
CONTEXT: Effective medical care assumes delivery of evidence-based medicines to appropriate patients with doses comparable to those studied. OBJECTIVE: To investigate dosing of unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), and glycopro ...
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Journal ArticleCirculation · November 15, 2005
BACKGROUND: Recent studies indicate that a routine invasive approach for patients with unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) yields improved outcomes compared with a conservative approach, but the optimal timing o ...
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Journal ArticleJ Am Coll Cardiol · October 18, 2005
OBJECTIVES: In a large contemporary population of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), we sought to describe blood transfusion rates (overall and in patients who did not undergo coronary artery bypass grafting [CABG]) ...
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Journal ArticleJ Am Coll Cardiol · October 18, 2005
OBJECTIVES: This study evaluated the impact of age on care and outcomes for non-ST-segment elevation acute coronary syndromes (NSTE ACS). BACKGROUND: Recent clinical trials have expanded treatment options for NSTE ACS, now reflected in guidelines. Elderly ...
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Journal ArticleAm J Cardiol · September 15, 2005
Despite the established benefit of drug-eluting stents (DESs) in improving clinical and angiographic outcomes in pivotal, randomized trials, relatively little is known regarding the frequency and patterns of DES use in clinical practice. To characterize DE ...
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Journal ArticleArch Intern Med · September 12, 2005
BACKGROUND: The threshold of troponin elevation that stimulates changes in clinical decision making for patients with non-ST-segment elevation acute coronary syndromes (NSTE ACSs) has not been previously evaluated. METHODS: A total of 23 298 patients with ...
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Journal ArticleArch Intern Med · July 25, 2005
BACKGROUND: Practice guidelines for acute ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) recommend similar therapies and interventions, but differences in patterns of care between MI categories have not been well described in con ...
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Journal ArticleAm Heart J · July 2005
BACKGROUND: Facilitated percutaneous coronary intervention (PCI)--simultaneous administration of glycoprotein IIb/IIIa inhibitors and reduced-dose fibrinolytics before primary PCI for ST-segment elevation myocardial infarction (STEMI)--may be a promising r ...
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Journal ArticleAm J Cardiol · June 15, 2005
Myocardial infarction (MI) is a key component of composite end points in trials that evaluate new therapies in non-ST-segment elevation acute coronary syndromes. Types of MI events in these trials have not been well characterized. A similar clinical-events ...
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Journal ArticleAm Heart J · June 2005
BACKGROUND: Although intravenous morphine is commonly used for the treatment of chest pain in patients presenting with non-ST-segment elevation acute coronary syndromes (NSTE ACS), its safety has not been evaluated. The CRUSADE Initiative is a nonrandomize ...
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Journal ArticleCritical Pathways in Cardiology · June 1, 2005
Few data are available from the registries on the impact of age and gender on treatment and outcomes of patients admitted for unstable angina and non-ST elevation myocardial infarction (UA/NSTEMI). We examined the clinical characteristics, differences in m ...
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Journal ArticleAcad Emerg Med · May 2005
OBJECTIVES: The authors analyzed contemporary use of glycoprotein (GP) IIb/IIIa inhibitors in patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) to determine patient selection patterns with early (<24 hours) GP IIb/IIIa inhibitor use ...
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Journal ArticleAnn Emerg Med · April 2005
The American College of Cardiology and the American Heart Association last published evidence-based guidelines for the management of ST-segment elevation myocardial infarction (STEMI) in 1999. In mid-2004, in recognition of the evolution and improvement of ...
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Journal ArticleAnn Emerg Med · April 2005
STUDY OBJECTIVE: Previous studies in clinical trial populations have demonstrated that patients presenting with positive troponin levels have a higher risk of mortality than patients with later positive troponin levels, but the influence of the timing of t ...
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Journal ArticleCirculation · March 15, 2005
BACKGROUND: Black patients with acute myocardial infarction are less likely than whites to receive coronary interventions. It is unknown whether racial disparities exist for other treatments for non-ST-segment elevation acute coronary syndromes (NSTE ACS) ...
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Journal ArticleJ Am Coll Cardiol · March 15, 2005
OBJECTIVES: We hypothesized that significant disparities in gender exist in the management of patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS). BACKGROUND: Gender-related differences in the diagnosis and treatment of ACS have im ...
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Journal ArticleAm Heart J · March 2005
BACKGROUND: Clinical trials provide evidence that is formulated into recommendations for practice guidelines, but it remains uncertain whether patients enrolled in trials are similar to those treated in routine practice and whether trial enrollment influen ...
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Journal ArticleAm J Cardiol · March 1, 2005
We compared combination fibrinolytic plus glycoprotein IIb/IIIa inhibitor therapy with stand-alone fibrinolysis with respect to speed and stability of reperfusion in patients who had acute ST-segment elevation myocardial infarction; data were obtained from ...
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Journal ArticleAm J Cardiol · February 15, 2005
We sought to characterize current patterns of care for lipid testing and management in a sample of patients in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Card ...
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Journal ArticleAm J Cardiol · January 15, 2005
Clinical and angiographic data were analyzed from 929 patients who had ST-elevation myocardial infarction and open epicardial arteries after fibrinolytic therapy. Residual angiographically evident thrombus was associated with more frequent Thrombolysis In ...
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Chapter · January 1, 2005
The challenge facing proponents of pharmacoinvasive therapy (1) lies in translating the potential synergistic benefits of a combined pharmacological and mechanical reperfusion strategy into real-world, clinical benefits. Evaluation of combined reperfusion ...
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Journal ArticleDrugs · 2005
Platelet glycoprotein (Gp) IIb/IIIa receptor antagonists improve outcomes in patients with acute coronary syndromes without persistent ST-segment elevation, but relative effects depend on appropriate patient selection. Recent data from the CRUSADE (Can Rap ...
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Journal ArticleAm Heart J · December 2004
BACKGROUND: Accurate risk stratification can guide clinical decision-making in the management of acute coronary syndromes (ACS). However, the applicability of risk models to the general ACS population remains unclear. The purpose of this study was to valid ...
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Journal ArticleJAMA · November 3, 2004
CONTEXT: The American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of non-ST-segment elevation acute coronary syndromes (NSTE ACS) recommend early invasive management for high-risk patients, given the benefits wi ...
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Journal ArticleAm Heart J · November 2004
Acute coronary syndromes (ACS), including non-ST-segment elevation (NSTE) ACS, represent a significant source of morbidity and mortality in the United States. To address this widespread, serious health problem, the American College of Cardiology and the Am ...
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Journal ArticleAm Heart J · November 2004
What does it take to make changes in practice and sustain those changes over time? This paper describes 3 successful attempts to improve the quality of care at US hospitals participating in the CRUSADE (Can Rapid risk stratification of Unstable angina pati ...
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Journal ArticleAm J Cardiol · July 1, 2004
The objective of this study was to determine the management and outcome of less [corrected] selected patients with an acute coronary syndrome during hospitalization and up to 1 year after discharge. The Canadian Acute Coronary Syndromes Registry was a pros ...
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Journal ArticleJ Am Coll Cardiol · June 16, 2004
The focus for the initial approach to the treatment of acute ST-segment elevation myocardial infarction (STEMI) has shifted toward extending the benefits of mechanical reperfusion with primary percutaneous coronary intervention (PCI) to patients who presen ...
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Journal ArticleAm J Cardiol · June 1, 2004
The restoration of epicardial and myocardial flow remains the primary goal of reperfusion therapy in patients with ST-segment elevation myocardial infarction, but the optimal method to assess this goal has not been defined. Thrombolysis In Myocardial Infar ...
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Journal ArticleAm Heart J · May 2004
BACKGROUND: More complete ST-segment resolution (ST res) in acute myocardial infarction (MI) has been associated with better epicardial and myocardial reperfusion as assessed with the Thrombolysis in Myocardial Infarction (TIMI) flow grade (TFG) and the TI ...
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Journal ArticleDiab Vasc Dis Res · May 2004
Patients with diabetes mellitus who present with acute ST-segment elevation myocardial infarction or non-ST-segment elevation acute coronary syndromes have a higher risk of adverse outcomes than patients without diabetes, and appear to derive greater benef ...
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Journal ArticleJ Am Coll Cardiol · April 7, 2004
OBJECTIVES: We hypothesized that recognition of systolic flow reversal (pulsatile flow) after thrombolytic administration on coronary angiography is associated with angiographic and electrocardiogram findings reflecting impaired myocardial perfusion, as we ...
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Journal ArticleJ Am Coll Cardiol · February 18, 2004
OBJECTIVES: This sub-study of the Integrilin and Tenecteplase in Acute Myocardial Infarction (INTEGRITI) trial evaluated of the impact of combination reperfusion therapy with reduced-dose tenecteplase plus eptifibatide on continuous ST-segment recovery and ...
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Journal ArticleEur Heart J · February 2004
AIM: To study the relationship between outcomes and peak creatine kinase (CK)-MB levels after percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). METHODS AND RESULTS: Peak CK-MB ratios (pe ...
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Journal ArticleAm J Med · January 15, 2004
Non-ST-segment elevation acute coronary syndromes are a dramatic manifestation of coronary artery disease. Multiple clinical trials have shown that early cardiac catheterization improves clinical outcomes in patients with non-ST-segment elevation acute cor ...
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Journal ArticleAm Heart J · December 2003
The therapeutic approach to patients with acute ST-segment elevation myocardial infarction (STEMI) has advanced rapidly over the past decade. Intravenous fibrinolytic therapy remains the most common form of reperfusion therapy worldwide, since fibrinolytic ...
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Journal ArticleAm Heart J · December 2003
BACKGROUND: The acute benefits of platelet glycoprotein IIb/IIIa inhibitors for non-ST-segment elevation acute coronary syndromes (NSTE ACS) remain unclear. METHODS: In this pilot trial, 311 patients with NSTE ACS were randomly assigned in the emergency de ...
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Journal ArticleAm Heart J · October 2003
Acute coronary syndromes (ACS) represent a major cause of morbidity and mortality for patients with cardiovascular disease, but evidence-based therapies shown to improve outcomes for ACS are often underused in clinically eligible patients. Although clinica ...
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Journal ArticleJ Am Coll Cardiol · July 2, 2003
OBJECTIVES: We sought to identify patient and hospital features associated with early glycoprotein (GP) IIb/IIIa inhibitor therapy for non-ST-elevation (NSTE) myocardial infarction (MI) and to relate this treatment to in-hospital outcomes. BACKGROUND: Glyc ...
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Journal ArticleAm J Emerg Med · July 2003
A prospective observational study was conducted in 2,007 patients experiencing chest pain to determine impact of local quality improvement (QI) measures on the use of glycoprotein (GP) IIb/IIIa inhibitors in the ED treatment of high-risk patients with non- ...
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Journal ArticleJ Thromb Thrombolysis · June 2003
BACKGROUND: Shorter distances from the coronary ostia to culprit lesions have been associated with a higher incidence of adverse outcomes in ST elevation acute myocardial infarction (STEMI). As drug-eluting stents are associated with low rates of restenosi ...
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Journal ArticleJ Am Coll Cardiol · April 16, 2003
OBJECTIVES: The goal of this study was to evaluate combinations of eptifibatide with reduced-dose tenecteplase (TNK) in ST-elevation myocardial infarction (STEMI). BACKGROUND: Glycoprotein IIb/IIIa inhibitors enhance thrombolysis. The role of combination t ...
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Journal ArticleAnn Emerg Med · March 2003
The publication of comprehensive evidence-based guidelines for the management of non-ST-segment elevation acute coronary syndrome by the American College of Cardiology and the American Heart Association in September 2000 marked a sentinel event in the evol ...
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Journal ArticleCardiovascular Reviews and Reports · March 1, 2003
The role of platelet aggregation is pivotal in the pathophysiology of non-ST-elevation acute coronary syndromes. The inhibition of the platelet glycoprotein IIb/IIIa receptor has been shown to reduce adverse cardiac events in patients with non-ST-segment e ...
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Journal ArticleJ Thromb Thrombolysis · December 2002
BACKGROUND: Receptors other than GP IIb/IIIa may mediate leukocyte-platelet-endothelial interactions that obstruct the microvasculature in acute coronary syndromes (ACS) and cause microinfarcts. The effect of eptifibatide on these receptors was investigate ...
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Journal ArticleAm Heart J · December 2002
BACKGROUND: Low-molecular-weight heparin (LMWH) has a more predictable anticoagulant effect than unfractionated heparin (UFH), is easier to administer, and does not require monitoring. Minimal data are available on LMWH combined with platelet glycoprotein ...
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Journal ArticleAcad Emerg Med · November 2002
Although acute coronary syndromes (ACS) represent a well-recognized source of morbidity and mortality for patients with cardiovascular disease, evidence-based therapies shown to improve outcomes for ACS are frequently underused in appropriate patients, esp ...
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Journal ArticleAm Heart J · February 2002
BACKGROUND: Myocardial (re)infarction (MI), a common trial end point, can be difficult to identify because of inconclusive signs and symptoms. We examined disagreement between investigator and clinical events committee (CEC) reporting of MIs in an internat ...
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Journal ArticleDrugs Aging · 2002
Evidence-based management of acute coronary syndromes (ACS) without persistent ST segment elevation involves a rational, stepwise approach to the selection of therapies with potential benefit for elderly patients. Specifically, in elderly patients with ACS ...
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Journal ArticleHeartDrug · December 1, 2001
Combination reperfusion therapy with partial-dose fibrinolytics and glycoprotein (GP) IIb/IIIa inhibitors for patients with acute myocardial infarction has been shown to accelerate and improve reperfusion compared with fibrinolytic monotherapy. Tenecteplas ...
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Journal ArticleAm J Cardiol · July 15, 2001
The feasibility and safety of simultaneous multivessel percutaneous coronary intervention during mechanical reperfusion for acute myocardial infarction was analyzed in a retrospective, case-controlled study. Patients who underwent multivessel coronary inte ...
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Journal ArticleAm Heart J · July 2001
BACKGROUND: Newer methods of coronary revascularization are being investigated in patients who are not candidates for coronary artery bypass grafting or percutaneous intervention. Our objective was to determine the proportion of patients eligible for newer ...
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Journal ArticleLancet · April 7, 2001
BACKGROUND: Lipid-lowering agents are known to reduce long-term mortality in patients with stable coronary disease or significant risk factors. However, the effect of lipid-lowering therapy on short-term mortality immediately after an acute coronary syndro ...
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Journal ArticleAm J Cardiol · March 1, 2001
Platelet glycoprotein IIb/IIIa inhibitors have been extensively studied in the treatment of patients with ischemic heart disease. Data regarding the use of these agents in the absence of concomitant intravenous heparin have been conflicting. We sought to d ...
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Journal ArticleCardiovasc Toxicol · 2001
A new variable termed the falloff constant (k(f)) was derived from the curve fitting of serial CK-MB measurements. k(f) represents the rate constant of maximal decline in serum CK-MB and is determined from the slope of the lognormal curve at the inflection ...
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Journal ArticleJ Am Coll Cardiol · January 2001
Successful reperfusion after acute myocardial infarction (MI) has traditionally been considered to be restoration of epicardial patency, but increasing evidence suggests that disordered microvascular function and inadequate myocardial tissue perfusion are ...
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Journal ArticleCirculation · December 12, 2000
BACKGROUND: Patients with a recent episode of non-ST-segment elevation acute coronary syndrome before CABG have higher rates of operative morbidity and mortality than patients with stable coronary syndromes. The efficacy of administering eptifibatide to th ...
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Journal ArticleCirculation · September 5, 2000
BACKGROUND: A proportion of patients who present with suspected acute coronary syndrome (ACS) are found to have insignificant coronary artery disease (CAD) during coronary angiography, but these patients have not been well characterized. METHODS AND RESULT ...
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Journal ArticleCurr Cardiol Rep · September 2000
Successful reperfusion following acute myocardial infarction is considered to be restoration of epicardial infarct vessel patency, but recent studies suggest that disrupted microvascular function and inadequate myocardial tissue perfusion are often present ...
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Journal ArticleAm Heart J · June 2000
BACKGROUND: Although transesophageal echocardiography (TEE) is more sensitive than transthoracic echocardiography (TTE) in detecting echocardiographic evidence of infective endocarditis (IE), the impact of TEE on the clinical diagnosis of IE has not been c ...
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Journal ArticleCleve Clin J Med · February 2000
Glycoprotein (GP) IIb/IIIa inhibitors are potent antiplatelet agents and represent an exciting breakthrough in the treatment of acute coronary syndromes. However, their safety and cost-effectiveness require further investigation, and more information on ri ...
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Journal ArticleAm J Cardiol · September 1, 1999
This study examines the proportion of patients with ischemic heart disease who may be candidates for the newer modalities of revascularization. A significant proportion (approximately 5%) of patients who undergo coronary angiography at tertiary referral ce ...
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Journal ArticleJ Neuropathol Exp Neurol · March 1996
The functional significance of microglia found in neuritic plaques in Alzheimer's disease (AD) remains a source of controversy. In the present study, we explored the anatomic relationships between microglia and neuritic plaques in order to determine the po ...
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Journal ArticleInfect Control Hosp Epidemiol · January 1996
OBJECTIVE: To determine the prevalence of gastrointestinal tract colonization with antibiotic-resistant enterococci at ward entry and to study the incidence and risk factors for nosocomial acquisition of colonization with resistant enterococci. DESIGN: A p ...
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