ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Coronary artery disease (CAD) is the number one cause of death and disability in women and men in the United States. In women, CAD typically develops after menopause, and, therefore, it has been hypothesized that estrogen replacement therapy (ERT) may have a role in preventing and treating CAD. Indeed, a body of epidemiologic data suggests that estrogen does protect against CAD. Much information is also available on the mechanisms by which estrogen may confer protection versus CAD. For example, ERT has been shown to have an overall beneficial effect on cardiac risk factors such as hyper-lipidemia in postmenopausal women, but the degree to which ERT affects the lipid profile and other risk factors is relatively modest and does not seem to account for all of the benefits of estrogen. Thus, this review focuses not only on the effects of ERT on cardiac risk factors but also on other aspects of CAD, such as atherogenesis, lipid oxidation, vasomotor tone, and thrombosis and thrombolysis. The recent literature on the effect of ERT on secondary prevention of cardiovascular events after percutaneous coronary interventions or coronary artery bypass surgery is also reviewed.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Intracoronary stenting improves the acute and long-term safety and efficacy of percutaneous coronary interventions by minimizing the risks of abrupt closure and late restenosis. Enhanced designs of new coronary stents will continue to expand the spectrum of coronary anatomy and clinical settings amenable to nonsurgical revascularization. Improvements in deliverability, application to complex lesions, and durability of results are direct effects of improved design characteristics. Future design features may also include incorporating adjunctive therapies such as antithrombotic or antiproliferative agents with stent-based delivery systems. Results of new stent registries and randomized clinical trials are reviewed.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Over 400,000 percutaneous transluminal coronary angioplasties (PTCAs) are currently performed annually in the United States. Approximately 10% of these procedures include rotational atherectomy, although the national average rate of stent placements continues to increase in some centers to as high as 75%. The combination of rotational atherectomy and intra-coronary stent placement is between 2% and 7.5% of interventional procedures per year in the United States. This article reviews the existing literature on rotational atherectomy and stent implantation for complex lesions and describes the upcoming prospective, multicenter randomized Stent Implantation, Postrotational Atherectomy (SPORT) trial.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In evaluating patients with nondiagnostic initial clinical or electrocardiogram (ECG) findings for acute cardiac ischemia, continuous 12-lead ECG monitoring increases the detection of diagnostic ECG findings, including ST-segment elevation, in patients awaiting hospital admission. Rest scanning with tech-nitium-99m sestamibi is able to risk stratify low-moderate risk patients into lower and higher risk groups for cardiac events. Caveats include the reduced sensitivity of scanning of patients who are pain free and the need for follow-up exercise scans for patients free of perfusion defects at rest. Cardiac markers, particularly the troponins, show great promise for the detection of a larger part of the spectrum of acute coronary syndromes in the emergency department, including patients with minimal myocardial damage and higher risk for short-term death and nonfatal acute myocardial infarction. Accelerated diagnostic protocols using serial testing with cardiac markers, ECGs and then provocative testing over a 14-hour period, are feasible, safe, and cost-effective.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Time to treatment in acute myocardial infarction (MI) has been of great interest since the advent of thrombolytic therapy. The paradigm that has emerged is that rapid achievement of reperfusion, with either thrombolysis or primary angioplasty, minimizes infarct size, reduces the degree of left ventricular dysfunction, and improves survival. Recent studies have confirmed the benefit of reducing time to treatment with thrombolysis (between onset of pain to initiation of thrombolysis) and that of more rapid drug reperfusion time with more aggressive thrombolytic regimens (between initiation of thrombolytic therapy and actual achievement of reperfusion). Furthermore, their effects are additive (and in some cases synergistic), confirming the benefit of rapid reperfusion. For primary angioplasty, the same relationship has been observed: More rapid treatment seems to be associated with improved outcome. The “door-to-balloon” time is a major determinant of overall time to reperfusion and, as such, is a crucial component of the overall strategy. This paradigm can also be extended to the prehospital phase of treating acute MI in two ways: 1) for patients to rapidly identify the symptoms of acute MI and to present earlier to the hospital is critical in reducing overall time to treatment and 2) in emergency medical care, rapid identification of MI patients, electrocardiographic monitoring, and defibrillation as needed for ventricular arrhythmias has been shown to be lifesaving. Thus, time to treatment in the current era of aggressive management of acute Ml extends far beyond the original description to every aspect of acute MI care.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Over the past two decades, new thrombolytic agents with sufficient pharmacologic potency and acceptable clinical safety profiles to treat thrombotic vascular occlusive syndromes, such as acute myocardial infarction, pulmonary embolism, acute peripheral and arterial thrombotic occlusions and deep vein thrombosis, have been developed and evaluated. The evolution of thrombolysis and its application to clinical cardiology came as a consequence of understanding the systems of coagulation and fibrinolysis and their role in the pathogenesis of acute coronary syndromes.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

There are many limitations to reperfusion therapy for acute myocardial infarction. Preliminary studies have explored the potential of using more potent antiplatelet therapy. Abciximab, eptifibatide, and lamifiban are new agents that inhibit platelet glycoprotein IIb/IIIa, which serves as the final common pathway for platelet aggregation. Infarct artery patency occurs more rapidly, normal coronary blood flow is more often restored, and reperfusion is more stable when these agents are used with standard- or reduced-dose fibrinolytic therapy. Moreover, abciximab monotherapy has thrombolytic activity and facilitates primary angioplasty or stenting. Further studies are needed to define safety, efficacy, and cost effectiveness.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

It has been widely reported throughout studies comparing mechanical reperfusion by primary percutaneous transluminal coronary angioplasty (PTCA) with thrombolytic therapy in acute myocardial infarction (AMI) that PTCA results in reduced rates of in-hospital mortality, reinfarction, recurrent ischemia, and stroke, allowing earlier hospital discharge with similar total costs. The attraction of primary PTCA is its relative simplicity and predictability with operators who have a wide range of experience with PTCA. With these results, it is legitimate to wonder what, if any, possible advantages other reperfusion approaches, such as stenting, might offer compared with primary PTCA. In addition, there is concern that newer reperfusion modalities may complicate an otherwise straightforward procedure and increase hospital expenditures. However, as effective as primary PTCA is, there is still room for improvement. Limitations of reperfusion by primary PTCA in AMI include recurrent ischemia in 10% to 1 5% of patients, restenosis in 37% to 49%, and late infarct artery reocclusion in 9% to 14%. By reducing the residual stenosis and sealing dissection planes created by PTCA, primary stenting may further improve short- and long-term outcomes after mechanical reperfusion. Consequently, interest in using stents in the setting of AMI has increased dramatically in the past several years. The results of various recent clinical studies confirm that primary stenting is safe and reasonable in the majority of patients with AMI and produces short-term outcomes superior to experience with primary PTCA.

ISSN:0268-4705    

出版商:OVID    

年代:1998

数据来源: OVID