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Robert M Califf - One of the best experts on this subject based on the ideXlab platform.
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angiographic outcomes with early eptifibatide therapy in non ST Segment Elevation acute coronary syndrome from the early acs trial
American Journal of Cardiology, 2014Co-Authors: Vijay Kunadian, Robert P Giugliano, Robert M Califf, Gilles Montalescot, Kristin L Newby, Cafer Zorkun, Jianping Guo, Akshay Bagai, Eugene Braunwald, Frans Van De WerfAbstract:Early adminiSTration of glycoprotein IIbIIIa inhibitors results in improved angiographic parameters, including thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frame count, and TIMI myocardial perfusion grade (TMPG) among patients with ST-Segment Elevation myocardial infarction. Whether the same is true in the setting of non–ST-Segment Elevation acute coronary syndrome is unknown. The goal of the early glycoprotein IIbIIIa inhibition in non–ST-Segment Elevation acute coronary syndrome (EARLY ACS) angiographic subSTudy was to compare angiographic outcomes among patients with non–ST-Segment Elevation acute coronary syndrome who were adminiSTered early routine versus delayed provisional eptifibatide. Of 9,406 patients in the EARLY ACS trial, 2,066 patients were included in the angiographic subSTudy (early routine eptifibatide [n = 1,042] or early placebo [n = 1,024] with delayed provisional eptifibatide after angiography and before percutaneous coronary intervention [PCI]). The angiographic subSTudy primary end point was the incidence of TMPG 3 before and after PCI. TMPG 3 before (43.7% vs 44.9%, p = 0.58) and after PCI (52.4% vs 50.1%, p = 0.73) was similar for early routine versus delayed provisional eptifibatide, respectively. Angiographic procedural complications consiSTing of a composite of loss of side branch, abrupt vessel closure, diSTal embolization, and no reflow occurred less frequently in early routine group versus delayed provisional group (9.3% vs 13.6%, respectively, p = 0.01). In the EARLY ACS angiographic subSTudy, the use of early routine eptifibatide resulted in fewer angiographic procedural complications. These data provide support for the use of eptifibatide in the catheterization laboratory during high-risk cases merely to prevent angiographic procedural complications.
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extent of ST Segment depression and cardiac events in non ST Segment Elevation acute coronary syndromes
European Heart Journal, 2005Co-Authors: Stefano Savonitto, Galen S Wagner, Karen S Pieper, Mauricio G Cohen, Alessandro Politi, Michael P Hudson, David F Kong, Yao Huang, Francesco Mauri, Robert M CaliffAbstract:Aims We sought to determine whether the extent of myocardial ischaemia on the admission electrocardiogram (ECG) has independent predictive value for short-term risk STratification of patients with non-ST-Segment Elevation acute coronary syndromes (NSTE ACS). Although the presence of ischaemic ECG changes on admission has been shown to predict outcome, the relationship between the extent of ECG changes and the risk of cardiac events is STill ill defined. Methods and results We analysed the admission ECGs of 5192 ACS patients enrolled in the GUSTO-IIb trial, without an ECG indication for thrombolysis. ECG tracings showing one or more of the following were eligible: ST-Segment depression >0.5 mm, T-wave inversion >1 mm, and ST-Segment Elevation >0.5 mm but <1 mm. ECG variables associated with unfavourable 30 day outcomes in a univariable analysis were further assessed in a multivariable logiSTic regression model including independent clinical predictors. In the multivariable clinical, enzymatic, and ECG model, the sum of ST-Segment depression (in millimetres) in all leads was a powerful independent predictor of 30 day death ( P <0.0001), with a continuous increase in risk with the extent of ST-Segment depression. The sum of ST-Segment depression ( P <0.0001) and the presence of minimal inferior ST-Segment Elevation ( P <0.0001) or anterior ST-Segment Elevation ( P =0.0182) were also independent predictors of the composite of death and myocardial infarction or reinfarction. The extent of ST-Segment depression showed a highly significant correlation with the prevalence of three-vessel ( P <0.0001) or left main coronary disease ( P <0.0001), and also with the peak levels of creatine kinase ( P <0.0001) during the index episode of ACS. Conclusion In patients with NSTE ACS, the sum of ST-Segment depression in all ECG leads is a powerful predictor of all-cause mortality at 30 days, independent of clinical variables and correlates with the extent and severity of coronary artery disease. The presence of even minimal (<1 mm) ST-Segment Elevation in anterior or inferior leads is independently associated with adverse outcomes.
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comparative prognoSTic significance of simultaneous versus independent resolution of ST Segment depression relative to ST Segment Elevation during acute myocardial infarction
Journal of the American College of Cardiology, 1997Co-Authors: Akbar Shah, Robert M Califf, Galen S Wagner, Robin Boineau, Cynthia L Green, Nancy M Wildermann, Kathleen M Trollinger, James E Pope, Mitchell W KrucoffAbstract:AbSTract Objectives. We sought to determine the prognoSTic significance of simultaneous versus independent resolution of ST Segment depression that occurs concomitant with ST Segment Elevation during acute myocardial infarction (AMI). Background. ST Segment depression in leads other than those showing ST Segment Elevation during AMI is a common phenomenon. Whether this indicates adverse outcomes remains controversial. We hypothesized that the timing of ST Segment depression resolution relative to ST Segment Elevation resolution might differentiate between a high risk group and a low risk group of patients. Methods. Continuous 12-lead ST Segment monitoring was performed after thrombolytic therapy for AMI in 413 patients, 261 of whom met technical criteria for analysis. Blinded analysis of ST Segment depression resolution patterns was used to group patients as follows: 1) no ST Segment depression at any time (control group); 2) ST Segment depression resolving simultaneously with ST Segment Elevation (simultaneous group); and 3) ST Segment depression persiSTing after ST Segment Elevation resolution (independent group). These patterns were correlated with the outcomes—recurrent angina, reinfarction, heart failure and death—using chi-square analysis and the Fisher exact teST for categoric variables and the Wilcoxon rank-sum teST for continuous variables. Results. The incidence of recurrent angina, reinfarction and heart failure was similar among the three groups. In-hospital mortality, however, was significantly higher in the independent group (13%) than either the simultaneous group (1%, p Conclusions. Continuous analysis of ST Segment resolution identifies, among patients with AMI with concomitantly occurring ST Segment Elevation and depression, a subgroup with increased in-hospital mortality. The pathogenic mechanism of increased mortality is not currently known.
Charles Antzelevitch - One of the best experts on this subject based on the ideXlab platform.
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ranolazine a new antiarrhythmic agent for patients with non ST Segment Elevation acute coronary syndromes
Nature Reviews Cardiology, 2008Co-Authors: Charles AntzelevitchAbstract:Ranolazine: a new antiarrhythmic agent for patients with non-ST-Segment Elevation acute coronary syndromes?
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cellular basis for the brugada syndrome and other mechanisms of arrhythmogenesis associated with ST Segment Elevation
Circulation, 1999Co-Authors: Charles AntzelevitchAbstract:Background—The Brugada syndrome is characterized by marked ST-Segment Elevation in the right precordial ECG leads and is associated with a high incidence of sudden and unexpected arrhythmic death. Our STudy examines the cellular basis for this syndrome. Methods and Results—Using arterially perfused wedges of canine right ventricle (RV), we simultaneously recorded transmembrane action potentials from 2 epicardial and 1 endocardial sites, together with unipolar electrograms and a transmural ECG. Loss of the action potential dome in epicardium but not endocardium after exposure to pinacidil (2 to 5 μmol/L), a K+ channel opener, or the combination of a Na+ channel blocker (flecainide, 7 μmol/L) and acetylcholine (ACh, 2 to 3 μmol/L) resulted in an abbreviation of epicardial response and a transmural dispersion of repolarization, which caused an ST-Segment Elevation in the ECG. ACh facilitated loss of the action potential dome, whereas isoproterenol (0.1 to 1 μmol/L) reSTored the epicardial dome, thus reducing...
Robert P Giugliano - One of the best experts on this subject based on the ideXlab platform.
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angiographic outcomes with early eptifibatide therapy in non ST Segment Elevation acute coronary syndrome from the early acs trial
American Journal of Cardiology, 2014Co-Authors: Vijay Kunadian, Robert P Giugliano, Robert M Califf, Gilles Montalescot, Kristin L Newby, Cafer Zorkun, Jianping Guo, Akshay Bagai, Eugene Braunwald, Frans Van De WerfAbstract:Early adminiSTration of glycoprotein IIbIIIa inhibitors results in improved angiographic parameters, including thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frame count, and TIMI myocardial perfusion grade (TMPG) among patients with ST-Segment Elevation myocardial infarction. Whether the same is true in the setting of non–ST-Segment Elevation acute coronary syndrome is unknown. The goal of the early glycoprotein IIbIIIa inhibition in non–ST-Segment Elevation acute coronary syndrome (EARLY ACS) angiographic subSTudy was to compare angiographic outcomes among patients with non–ST-Segment Elevation acute coronary syndrome who were adminiSTered early routine versus delayed provisional eptifibatide. Of 9,406 patients in the EARLY ACS trial, 2,066 patients were included in the angiographic subSTudy (early routine eptifibatide [n = 1,042] or early placebo [n = 1,024] with delayed provisional eptifibatide after angiography and before percutaneous coronary intervention [PCI]). The angiographic subSTudy primary end point was the incidence of TMPG 3 before and after PCI. TMPG 3 before (43.7% vs 44.9%, p = 0.58) and after PCI (52.4% vs 50.1%, p = 0.73) was similar for early routine versus delayed provisional eptifibatide, respectively. Angiographic procedural complications consiSTing of a composite of loss of side branch, abrupt vessel closure, diSTal embolization, and no reflow occurred less frequently in early routine group versus delayed provisional group (9.3% vs 13.6%, respectively, p = 0.01). In the EARLY ACS angiographic subSTudy, the use of early routine eptifibatide resulted in fewer angiographic procedural complications. These data provide support for the use of eptifibatide in the catheterization laboratory during high-risk cases merely to prevent angiographic procedural complications.
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effectiveness and safety of percutaneous coronary intervention after fibrinolytic therapy for ST Segment Elevation acute myocardial infarction
American Journal of Cardiology, 2011Co-Authors: Suzanne J Baron, Robert P GiuglianoAbstract:The goal of treatment of an acute ST-Segment Elevation myocardial infarction is the timely reSToration of myocardial blood flow to decrease myocardial necrosis and thereby preserve cardiac tissue and overall function. MainSTays of reperfusion treatment include fibrinolytic therapy and/or primary percutaneous coronary intervention. In those patients who are treated with fibrinolysis, there is debate as to whether and when they should also undergo subsequent percutaneous coronary intervention. In conclusion, the inveSTigators review the published reports on sySTematic percutaneous coronary intervention after fibrinolytic therapy in the treatment of ST-Segment Elevation myocardial infarction and discuss the rationale behind this treatment STrategy.
S Kilinc - One of the best experts on this subject based on the ideXlab platform.
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ST Segment Elevation mimicking acute myocardial infarction in hypercalcaemia
Heart, 2005Co-Authors: S Turhan, M Kilickap, S KilincAbstract:A 56 year old man was admitted to our clinic with the diagnosis of ST Segment Elevation myocardial infarction (MI). He had prolonged burning, crushing type of cheST pain, and his ECG showed ST Segment Elevation in leads V1–V6, I, and II, and small Q waves in leads V2 and V3 …
Frans Van De Werf - One of the best experts on this subject based on the ideXlab platform.
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angiographic outcomes with early eptifibatide therapy in non ST Segment Elevation acute coronary syndrome from the early acs trial
American Journal of Cardiology, 2014Co-Authors: Vijay Kunadian, Robert P Giugliano, Robert M Califf, Gilles Montalescot, Kristin L Newby, Cafer Zorkun, Jianping Guo, Akshay Bagai, Eugene Braunwald, Frans Van De WerfAbstract:Early adminiSTration of glycoprotein IIbIIIa inhibitors results in improved angiographic parameters, including thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frame count, and TIMI myocardial perfusion grade (TMPG) among patients with ST-Segment Elevation myocardial infarction. Whether the same is true in the setting of non–ST-Segment Elevation acute coronary syndrome is unknown. The goal of the early glycoprotein IIbIIIa inhibition in non–ST-Segment Elevation acute coronary syndrome (EARLY ACS) angiographic subSTudy was to compare angiographic outcomes among patients with non–ST-Segment Elevation acute coronary syndrome who were adminiSTered early routine versus delayed provisional eptifibatide. Of 9,406 patients in the EARLY ACS trial, 2,066 patients were included in the angiographic subSTudy (early routine eptifibatide [n = 1,042] or early placebo [n = 1,024] with delayed provisional eptifibatide after angiography and before percutaneous coronary intervention [PCI]). The angiographic subSTudy primary end point was the incidence of TMPG 3 before and after PCI. TMPG 3 before (43.7% vs 44.9%, p = 0.58) and after PCI (52.4% vs 50.1%, p = 0.73) was similar for early routine versus delayed provisional eptifibatide, respectively. Angiographic procedural complications consiSTing of a composite of loss of side branch, abrupt vessel closure, diSTal embolization, and no reflow occurred less frequently in early routine group versus delayed provisional group (9.3% vs 13.6%, respectively, p = 0.01). In the EARLY ACS angiographic subSTudy, the use of early routine eptifibatide resulted in fewer angiographic procedural complications. These data provide support for the use of eptifibatide in the catheterization laboratory during high-risk cases merely to prevent angiographic procedural complications.
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vorapaxar in non ST Segment Elevation acute coronary syndrome patients with peripheral artery disease results from tracer
Circulation, 2013Co-Authors: Schuyler Jones, Frans Van De Werf, Pierluigi Tricoci, Zhen Huang, David J Moliterno, Robert A Harrington, Peter Sinnaeve, John Strony, Harvey D White, Claes HeldAbstract:Vorapaxar in Non-ST-Segment Elevation Acute Coronary Syndrome Patients With Peripheral Artery Disease : Results From TRACER