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Circulation 2010-11-23

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Abstract 1 of 7
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Arrhythmia/Electrophysiology

Factors Associated With Pulseless Electric Activity Versus Ventricular Fibrillation
The Oregon Sudden Unexpected Death Study
Carmen Teodorescu, MD, PhD; Kyndaron Reinier, PhD; Celia Dervan, MD; Audrey Uy-Evanado, MD; Mershed Samara, MD; Ronald Mariani, EMT-P; Karen Gunson, MD; Jonathan Jui, MD, MPH; Sumeet S. Chugh, MD
From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif (C.T., K.R., A.U-E., R.M., S.S.C.); and Departments of Emergency Medicine (C.D., M.S., J.J.) and Pathology (K.G.), Oregon Health and Science University, Portland, Ore.

Correspondence to Sumeet S. Chugh, MD, The Heart Institute, 5702 South Tower, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048. E-mail sumeet.chugh@cshs.org

Background— Corresponding with a continuing decline in the prevalence of sudden cardiac arrest cases presenting with ventricular fibrillation (VF), there has been a significant rise in the prevalence of pulseless electrical activity (PEA). Given significantly lower survival from PEA versus VF, we comprehensively investigated PEA correlates by incorporating first-responder data with lifetime clinical history information.

Methods and Results— In the Portland, Ore, metropolitan area (population 1 million), cases of out-of-hospital sudden cardiac arrest who underwent attempted resuscitation were identified prospectively (2002–2007). Those presenting with PEA versus VF and asystole were compared with 2 tests, ANOVA, and logistic regression. A total of 1277 cases aged 18 years underwent resuscitation by first responders (mean age, 65±16 years; 67% male). Presenting arrhythmia was VF in 48%, PEA in 25%, and asystole/other in the remainder. Compared with VF cases, PEA cases were older (mean age, 68 versus 63 years; P=0.0002), more likely to be female (37% versus 26%; P=0.0008), and less likely to survive to hospital discharge (6% versus 25%; P<0.0001). A history of syncope was strongly associated with PEA (odds ratio, 2.6; confidence interval, 1.3 to 5.3) after adjustment for age, gender, response time, and arrest circumstances. Black race was also independently associated with PEA (odds ratio, 2.6; confidence interval, 1.3 to 5.4). Pulmonary disease and female gender were significant factors associated with PEA (P for interaction=0.04). In a subgroup analysis of resting ECGs (n=391), there were no differences in cardiac clinical history or prevalence of cardiac conduction system disease (PEA, 31.6% versus VF, 32.2%; P=0.48).

Conclusions— PEA cases had a significantly higher prevalence of syncope in their lifetime, with other correlates, including black race, that were distinct from VF cases. Potential mechanistic links between syncope and future manifestation with PEA warrant further exploration.

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Clinical Perspective
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Abstract 2 of 7
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Congenital Heart Disease

Corticosteroids and Outcome in Children Undergoing Congenital Heart Surgery
Analysis of the Pediatric Health Information Systems Databas
Sara K. Pasquali, MD; Matthew Hall, PhD; Jennifer S. Li, MD, MHS; Eric D. Peterson, MD, MPH; James Jaggers, MD; Andrew J. Lodge, MD; Bradley S. Marino, MD, MPP, MSCE; Denise M. Goodman, MD; Samir S. Shah, MD, MSCE
From the Divisions of Pediatric Cardiology (S.K.P., J.S.L.), Cardiothoracic Surgery (J.J., A.J.L.), and Cardiology (E.D.P.), Departments of Pediatrics, Surgery, and Medicine, Duke University Medical Center, and Duke Clinical Research Institute (S.K.P., J.S.L., E.D.P.), Durham, NC; Child Health Corporation of America, Shawnee Mission, Kan (M.H.); Divisions of Cardiology and Critical Care, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (B.S.M.); Division of Pediatric Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, and Children's Memorial Hospital, Chicago, Ill (D.M.G.); and Division of Infectious Disease, Department of Pediatrics, and Center for Clinical Epidemiology and Biostatistics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pa (S.S.S.).

Correspondence to Sara K. Pasquali, MD, Assistant Professor of Pediatrics, Division of Cardiology, Department of Pediatrics, Duke University Medical Center, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail sara.pasquali@duke.edu

Background— Children undergoing congenital heart surgery often receive corticosteroids with the aim of reducing the inflammatory response after cardiopulmonary bypass; however, the value of this approach is unclear.

Methods and Results— The Pediatric Health Information Systems Database was used to evaluate outcomes associated with corticosteroids in children (0 to 18 years of age) undergoing congenital heart surgery at 38 US centers from 2003 to 2008. Propensity scores were constructed to account for potential confounders: age, sex, race, prematurity, genetic syndrome, type of surgery (Risk Adjustment in Congenital Heart Surgery [RACHS-1] category), center, and center volume. Multivariable analysis, adjusting for propensity score and individual covariates, was performed to evaluate in-hospital mortality, postoperative length of stay, duration of ventilation, infection, and use of insulin. A total of 46 730 children were included; 54% received corticosteroids. In multivariable analysis, there was no difference in mortality among corticosteroid recipients and nonrecipients (odds ratio, 1.13; 95% confidence interval, 0.98 to 1.30). Corticosteroids were associated with longer length of stay (least square mean difference, 2.18 days; 95% confidence interval, 1.62 to 2.74 days), greater infection (odds ratio, 1.27; 95% confidence interval, 1.10 to 1.46), and greater use of insulin (odds ratio, 2.45; 95% confidence interval, 2.24 to 2.67). There was no difference in duration of ventilation. In analysis stratified by RACHS-1 category, no significant benefit was seen in any group, and the association of corticosteroids with increased morbidity was most prominent in RACHS-1 categories 1 through 3.

Conclusion— In this observational analysis of children undergoing congenital heart surgery, we were unable to demonstrate a significant benefit associated with corticosteroids and found that corticosteroids may be associated with increased morbidity, particularly in lower-risk patients.

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Clinical Perspective
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Abstract 3 of 7
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Coronary Heart Disease

Ticagrelor Versus Clopidogrel in Patients With ST-Elevation Acute Coronary Syndromes Intended for Reperfusion With Primary Percutaneous Coronary Intervention
A Platelet Inhibition and Patient Outcomes (PLATO) Trial Subgroup Analysis
Philippe Gabriel Steg, MD; Stefan James, MD, PhD; Robert A. Harrington, MD; Diego Ardissino, MD; Richard C. Becker, MD; Christopher P. Cannon, MD; Håkan Emanuelsson, MD, PhD; Ariel Finkelstein, MD; Steen Husted, MD, DSc; Hugo Katus, MD; Jan Kilhamn, MD, PhD; Sylvia Olofsson, BSc; Robert F. Storey, MD, DM; W. Douglas Weaver, MD; Lars Wallentin, MD, PhD; for the PLATO Study Group
From INSERM U-698, Paris, France (P.G.S.); Hôpital Bichat-Claude Bernard, AP-HP, Paris, France (P.G.S.); Université Paris 7, Paris, France (P.G.S.); Uppsala Clinical Research Center and Department Medical Sciences, Uppsala University, Uppsala, Sweden (S.J., S.O., L.W.); Duke Clinical Research Institute, Durham, NC (R.A.H., R.C.B.); Azienda Ospedaliero Universitaria di Parma, Parma, Italy (D.A.); TIMI Study Group, Brigham and Women's Hospital, Boston, Mass (C.P.C.); AstraZeneca Research and Development, Mölndal, Sweden (H.E., J.K.); Tel-Aviv Medical Center, Tel-Aviv, Israel (A.F.); Århus University Hospital, Århus, Denmark (S.H.); Universitätsklinikum Heidelberg, Heidelberg, Germany (H.K.); University of Sheffield, Sheffield, UK (R.F.S.); and Henry Ford Hospital, Detroit, Mich (W.D.W.).

Correspondence to P. Gabriel Steg, Centre Hospitalier Bichat-Claude Bernard, 46 Rue H. Huchard, 75018 Paris, France. E-mail gabriel.steg@bch.aphp.fr

Background— Aspirin and clopidogrel are recommended for patients with acute coronary syndromes (ACS) or undergoing coronary stenting. Ticagrelor, a reversible oral P2Y12-receptor antagonist, provides faster, greater, and more consistent platelet inhibition than clopidogrel and may be useful for patients with acute ST-segment elevation (STE) ACS and planned primary percutaneous coronary intervention.

Methods and Result— Platelet Inhibition and Patient Outcomes (PLATO), a randomized, double-blind trial, compared ticagrelor with clopidogrel for the prevention of vascular events in 18 624 ACS patients. This report concerns the 7544 ACS patients with STE or left bundle-branch block allocated to either ticagrelor 180-mg loading dose followed by 90 mg twice daily or clopidogrel 300-mg loading dose (with provision for 300 mg clopidogrel at percutaneous coronary intervention) followed by 75 mg daily for 6 to 12 months. The reduction of the primary end point (myocardial infarction, stroke, or cardiovascular death) with ticagrelor versus clopidogrel (10.8% versus 9.4%; hazard ratio [HR], 0.87; 95% confidence interval, 0.75 to 1.01; P=0.07) was consistent with the overall PLATO results. There was no interaction between presentation with STE/left bundle-branch block and randomized treatment (interaction P=0.29). Ticagrelor reduced several secondary end points, including myocardial infarction alone (HR, 0.80; P=0.03), total mortality (HR, 0.82; P=0.05), and definite stent thrombosis (HR, 0.66; P=0.03). The risk of stroke, low in both groups, was higher with ticagrelor (1.7% versus 1.0%; HR,1.63; 95% confidence interval, 1.07 to 2.48; P=0.02). Ticagrelor did not affect major bleeding (HR, 0.98; P=0.76).

Conclusion— In patients with STE-ACS and planned primary percutaneous coronary intervention, the effects of ticagrelor were consistent with those observed in the overall PLATO trial.

Clinical Trial Registration— URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00391872.

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Clinical Perspective
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Abstract 4 of 7
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Coronary Heart Disease

What Is the Optimal Blood Pressure in Patients After Acute Coronary Syndromes?
Relationship of Blood Pressure and Cardiovascular Events in the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction (PROVE IT-TIMI) 22 Trial
Sripal Bangalore, MD, MHA; Jie Qin, MS; Sarah Sloan, MS; Sabina A. Murphy, MPH; Christopher P. Cannon, MD; for the PROVE IT-TIMI 22 Trial Investigators
From the New York University School of Medicine (S.B.), New York, NY, and TIMI Study Group (J.Q., S.S., S.A.M., C.P.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

Reprint requests to Dr Christopher P. Cannon, TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, 350 Longwood Ave, First Floor, Boston, MA 02115. E-mail cpcannon@partners.org

Background— Aggressive blood pressure (BP) control has been advocated in patients with acute coronary syndrome, but few data exist in this population relative to cardiovascular outcomes.

Methods and Results— We evaluated 4162 patients enrolled in the PRavastatin Or atorVastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial (acute coronary syndrome patients randomized to pravastatin 40 mg versus atorvastatin 80 mg). The average follow-up BP (systolic and diastolic) was categorized into 10-mm Hg increments. The primary outcome was a composite of death due to any cause, myocardial infarction, unstable angina requiring rehospitalization, revascularization after 30 days, and stroke. The secondary outcome was a composite of death due to coronary heart disease, nonfatal myocardial infarction, or revascularization. The relationship between BP (systolic or diastolic) followed a J- or U-shaped curve association with primary, secondary, and individual outcomes, with increased events rates at both low and high BP values, both unadjusted and after adjustment for baseline variables, baseline C-reactive protein, and on-treatment average levels of low-density lipoprotein cholesterol. A nonlinear Cox proportional hazards model showed a nadir of 136/85 mm Hg (range 130 to 140 mm Hg systolic and 80 to 90 mm Hg diastolic) at which the incidence of primary outcome was lowest. The curve was relatively flat for systolic pressures of 110 to 130 mm Hg and diastolic pressures of 70 to 90 mm Hg.

Conclusions— After acute coronary syndrome, a J- or U-shaped curve association existed between BP and the risk of future cardiovascular events, with lowest event rates in the BP range of approximately 130 to 140 mm Hg systolic and 80 to 90 mm Hg diastolic and a relatively flat curve for systolic pressures of 110 to 130 mm Hg and diastolic pressures of 70 to 90 mm Hg, which suggests that too low of a pressure (especially <110/70 mm Hg) may be dangerous.

Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00382460.

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Clinical Perspective
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Abstract 5 of 7
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Epidemiology and Prevention

OMEGA, a Randomized, Placebo-Controlled Trial to Test the Effect of Highly Purified Omega-3 Fatty Acids on Top of Modern Guideline-Adjusted Therapy After Myocardial Infarction
Bernhard Rauch, MD; Rudolf Schiele, MD; Steffen Schneider, PhD; Frank Diller; Norbert Victor, PhD; Helmut Gohlke, MD; Martin Gottwik, MD; Gerhard Steinbeck, MD; Ulrike Del Castillo; Rudolf Sack, MD; Heinrich Worth, MD; Hugo Katus, MD; Wilhelm Spitzer, MD; Georg Sabin, MD; Jochen Senges, MD; for the OMEGA Study Group
From the Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen (B.R., S.S., F.D., M.G., J.S.); Herzzentrum am Klinikum der Stadt Ludwigshafen, Ludwigshafen (R. Schiele); Institut für Medizinische Biometrie und Informatik, Universität Heidelberg, Heidelberg (N.V.); Herz-Zentrum Bad Krozingen, Bad Krozingen (H.G.); Medizinische Klinik und Poliklinik I, Klinikum Großhadern, München (G. Steinbeck); Trommsdorff Arzneimittel, Alsdorf (U.D.C.); Abteilung Kardiologie, Elisabeth-Krankenhaus, Recklinghausen (R. Sack); Medizinische Klinik I, Klinikum Fürth, Fürth (H.W.); Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg (H.K.); Medizinische Klinik, Klinik Neustadt/Aisch, Neustadt a.d. Aisch (W.S.); and Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus, Essen (G. Sabin), Germany.

Correspondence to Professor Dr Bernhard Rauch, Institut für Herzinfarktforschung Ludwigshafenan der Universität Heidelberg, Bremserstrasse 79, D-67063 Ludwigshafen, Germany. E-mail rauch@zar-kardio-ludwigshafen.de

Background— There is no randomized, double-blind trial testing the prognostic effect of highly purified omega-3 fatty acids in addition to current guideline-adjusted treatment of acute myocardial infarction.

Methods and Results— OMEGA is a randomized, placebo-controlled, double-blind, multicenter trial testing the effects of omega-3-acid ethyl esters-90 (1 g/d for 1 year) on the rate of sudden cardiac death in survivors of acute myocardial infarction, if given in addition to current guideline-adjusted treatment. Secondary end points were total mortality and nonfatal clinical events. Patients (n=3851; female, 25.6%; mean age, 64.0 years) were randomized in 104 German centers 3 to 14 days after acute myocardial infarction from October 2003 until June 2007. Acute coronary angiography was performed in 93.8% and acute percutaneous coronary intervention in 77.8% of all patients. During a follow-up of 365 days, the event rates were (omega and control groups) as follows: sudden cardiac death, 1.5% and 1.5% (P=0.84); total mortality, 4.6% and 3.7% (P=0.18); major adverse cerebrovascular and cardiovascular events, 10.4% and 8.8% (P=0.1); and revascularization in survivors, 27.6% and 29.1% (P=0.34).

Conclusions— Guideline-adjusted treatment of acute myocardial infarction results in a low rate of sudden cardiac death and other clinical events within 1 year of follow-up, which could not be shown to be further reduced by the application of omega-3 fatty acids.

Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00251134.

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Clinical Perspective
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Abstract 6 of 7
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Imaging

Ionizing Radiation Exposure to Patients Admitted With Acute Myocardial Infarction in the United States
Prashant Kaul, MD; Sofia Medvedev, PhD; Samuel F. Hohmann, PhD; Pamela S. Douglas, MD; Eric D. Peterson, MD,, MPH; Manesh R. Patel, MD
From the Division of Cardiovascular Medicine, Duke University Medical Center (P.K., P.S.D., E.D.P., M.R.P.), and Duke Clinical Research Institute (P.S.D., E.D.P., M.R.P.), Durham, NC, and University HealthSystem Consortium, Oak Brook, Ill (S.M., S.F.H.).

Correspondence to Manesh R. Patel, MD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail manesh.patel@duke.edu

Background— Invasive and noninvasive cardiovascular imaging is beneficial in the care of patients admitted with acute myocardial infarction. Little is known about patients' cumulative radiation exposure.

Methods and Results— All patients admitted with an acute myocardial infarction to any of 49 University HealthSystem Consortium member hospitals from 2006 to 2009 were reviewed for inpatient procedures involving ionizing radiation that included chest radiograph, computed tomogram scans, radionuclide imaging, diagnostic cardiac catheterization, and percutaneous coronary intervention. The average cumulative effective radiation dose per patient was estimated on the basis of published typical effective radiation doses for imaging procedures. Patients (n=64 071) admitted for acute myocardial infarction had a median age of 64.9 years. A total of 276 651 procedures involving ionizing radiation were performed during the study period, a median of 4.3 procedures per patient per admission. The majority of patients had invasive catheterization (77%), followed by computed tomogram scans (52%), mostly body examinations. The median cumulative effective radiation dose delivered was 15.02 mSv per patient per acute myocardial infarction admission. Postprocedural bleeding was a significant predictor of radiation exposure (odds ratio, 2.01; 95% confidence interval, 1.85 to 2.18), together with postprocedural mechanical complications resulting from device implantation (odds ratio, 2.86; 95% confidence interval, 2.61 to 3.13). Patients with higher underlying clinical complexity (defined by severity of illness scores) had higher radiation exposure and higher mortality (P<0.0001). There was also significant geographic variation in radiation exposure; patients in New England received the lowest cumulative exposure (odds ratio, 0.78; 95% confidence interval, 0.74 to 0.81).

Conclusions— Acute myocardial infarction inpatients are exposed to an approximate median radiation dose of 15 mSv. This exposure is a result of multiple cardiovascular and noncardiovascular procedures. Efforts should be made to understand the risks and benefits of radiation exposure per episode of care for acute myocardial infarction.

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Clinical Perspective
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Abstract 7 of 7
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Molecular Cardiology

Silent Information Regulator 1 Protects the Heart From Ischemia/Reperfusion
Chiao-Po Hsu, MD; Peiyong Zhai, MD, PhD; Takanobu Yamamoto, MD, PhD; Yasuhiro Maejima, MD, PhD; Shouji Matsushima, MD, PhD; Nirmala Hariharan, BS; Dan Shao, BS; Hiromitsu Takagi, PhD; Shinichi Oka, PhD; Junichi Sadoshima, MD, PhD
From the Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ (C.H., P.Z., T.Y., Y.M., S.M., N.H., D.S., H.T., S.O., J.S.); and National Yang-Ming University School of Medicine, Taipei, Taiwan (C.H.).

Correspondence to Junichi Sadoshima, Cardiovascular Research Institute, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 185 S Orange Ave, Medical Science Building G-609, Newark, NJ 07103. E-mail Sadoshju@umdnj.edu

Background— Silent information regulator 1 (Sirt1), a class III histone deacetylase, retards aging and protects the heart from oxidative stress. We here examined whether Sirt1 is protective against myocardial ischemia/reperfusion (I/R).

Methods and Results— Protein and mRNA expression of Sirt1 is significantly reduced by I/R. Cardiac-specific Sirt1–/– mice exhibited a significant increase (44±5% versus 15±5%; P=0.01) in the size of myocardial infarction/area at risk. In transgenic mice with cardiac-specific overexpression of Sirt1, both myocardial infarction/area at risk (15±4% versus 36±8%; P=0.004) and terminal deoxynucleotidyl transferase dUTP nick end labeling–positive nuclei (4±3% versus 10±1%; P<0.003) were significantly reduced compared with nontransgenic mice. In Langendorff-perfused hearts, the functional recovery during reperfusion was significantly greater in transgenic mice with cardiac-specific overexpression of Sirt1 than in nontransgenic mice. Sirt1 positively regulates expression of prosurvival molecules, including manganese superoxide dismutase, thioredoxin-1, and Bcl-xL, whereas it negatively regulates the proapoptotic molecules Bax and cleaved caspase-3. The level of oxidative stress after I/R, as evaluated by anti-8-hydroxydeoxyguanosine staining, was negatively regulated by Sirt1. Sirt1 stimulates the transcriptional activity of FoxO1, which in turn plays an essential role in mediating Sirt1-induced upregulation of manganese superoxide dismutase and suppression of oxidative stress in cardiac myocytes. Sirt1 plays an important role in mediating I/R-induced increases in the nuclear localization of FoxO1 in vivo.

Conclusions— These results suggest that Sirt1 protects the heart from I/R injury through upregulation of antioxidants and downregulation of proapoptotic molecules through activation of FoxO and decreases in oxidative stress.

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2010-11-23 08:43 浏览 : 3043 回复 : 11

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• #医生的昵称有多好笑#这是你们热爱工作的表现吗？哈哈哈哈

jianghw200918

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认领第7篇，48小时未交译文，请其他战友自由认领。

2010-11-23 11:26

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• 恒生医院处理压疮最新方式:白天康复，晚上纱布负压引流，效果也是杠杠滴

j2249599

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第四篇。

Coronary Heart Disease 冠心病

What Is the Optimal Blood Pressure in Patients After Acute Coronary Syndromes?
急性冠脉综合征后患者最理想的血压是多少？
Relationship of Blood Pressure and Cardiovascular Events in the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction (PROVE IT-TIMI) 22 Trial
普伐他汀或者阿伐他汀治疗作用的评估和抗感染治疗－心肌梗死溶栓治疗（PROVE IT-TIMI） 22试验中血压和心血管事件的关系

Background— Aggressive blood pressure (BP) control has been advocated in patients with acute coronary syndrome, but few data exist in this population relative to cardiovascular outcomes.
背景：对急性冠脉综合征患者一直强调强化血压控制，但与此相关的心血管结果却基本没什么资料。

Methods and Results— We evaluated 4162 patients enrolled in the PRavastatin Or atorVastatin Evaluation and Infection Therapy–Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial (acute coronary syndrome patients randomized to pravastatin 40 mg versus atorvastatin 80 mg). The average follow-up BP (systolic and diastolic) was categorized into 10-mm Hg increments. The primary outcome was a composite of death due to any cause, myocardial infarction, unstable angina requiring rehospitalization, revascularization after 30 days, and stroke. The secondary outcome was a composite of death due to coronary heart disease, nonfatal myocardial infarction, or revascularization. The relationship between BP (systolic or diastolic) followed a J- or U-shaped curve association with primary, secondary, and individual outcomes, with increased events rates at both low and high BP values, both unadjusted and after adjustment for baseline variables, baseline C-reactive protein, and on-treatment average levels of low-density lipoprotein cholesterol. A nonlinear Cox proportional hazards model showed a nadir of 136/85 mm Hg (range 130 to 140 mm Hg systolic and 80 to 90 mm Hg diastolic) at which the incidence of primary outcome was lowest. The curve was relatively flat for systolic pressures of 110 to 130 mm Hg and diastolic pressures of 70 to 90 mm Hg.
方法和结果：在PROVE IT-TIMI 22试验中共纳入4162例患者（急性冠脉综合征患者承受机分配到普伐他汀40mg组和阿托伐他汀 80mg组）。平均随访血压（收缩压和舒张压）按每10mmHg进行分类。初级终点包括全因死亡、心肌梗死、需再次入院的心绞痛、30天血管重建及卒中。次级终点为冠心病引起的死亡、非致死性心肌梗死或血管重建。血压（收缩压或舒张压）水平与初级终点、次级终点和个人结果存在J或U型曲线关系，基线变量、基线C－反应蛋白、治疗前低密度脂蛋白胆固醇校正前和校正后事件率在低位和高位血压值均增加。非线性Cox比例风险模型显示初级终点发生率最低时的血压值为136/85 mm Hg（收缩压130～140 mm Hg，舒张压80～90 mm Hg)。收缩压在110～130 mm Hg、舒张压在70～90 mm Hg水平时曲线相对平坦。

Conclusions— After acute coronary syndrome, a J- or U-shaped curve association existed between BP and the risk of future cardiovascular events, with lowest event rates in the BP range of approximately 130 to 140 mm Hg systolic and 80 to 90 mm Hg diastolic and a relatively flat curve for systolic pressures of 110 to 130 mm Hg and diastolic pressures of 70 to 90 mm Hg, which suggests that too low of a pressure (especially <110/70 mm Hg) may be dangerous.
结论：发生急性冠脉综合征后，血压水平与未来心血管事件间存在J或U型曲线关系，收缩压在130～140 mm Hg、舒张压在80～90 mm Hg水平时事件率最低，收缩压在110～130 mm Hg、舒张压在70～90 mm Hg水平时曲线相对平坦，这些结果表明血压太低（特别是<110/70 mm Hg）或许是危险的。

2010-11-23 12:09