5 research outputs found
Restenosis, reocclusion and adverse cardiovascular events after successful balloon angioplasty of occluded versus nonoccluded coronary arteries: Results from the multicenter american research trial with cilazapril after angioplasty to prevent transluminal coronary obstruction and restenosis (MARCATOR)
OBJECTIVES: This study sought to compare the frequency of restenosis, reocclusion and adverse cardiovascular events after angioplasty of occluded versus nonoccluded coronary arteries.
BACKGROUND: Angioplasty of chronically occluded coronary arteries is believed to be associated with a higher frequency of restenosis and reocclusion than angioplasty of subtotal stenoses. Whether this leads to adverse cardiovascular events is unknown.
METHODS: The Multicenter American Research Trial With Cilazapril After Angioplasty to Prevent Restenosis (MARCATOR) was a placebo-controlled trial with angiographic follow-up to determine the effect of the angiotensin-converting enzyme inhibitor cilazapril on the frequency of restenosis. In this trial, restenosis was defined as 1) angiographic reduction of minimal lumen diameter > or = 0.72 mm between angioplasty and the follow-up visit; and 2) > 50% diameter stenosis on the follow-up angiogram. We identified
Long-Term Results After the Glycoprotein IIb/IIIa Inhibitor Abciximab in Unstable Angina
BACKGROUND: This study was designed to investigate long-term effects of the glycoprotein IIb/IIIa inhibitor abciximab in patients with acute coronary syndrome without ST elevation who were not scheduled for coronary intervention. METHODS AND RESULTS: A total of 7800 patients were included with an acute coronary syndrome without ST elevation, documented by either elevated cardiac troponin or transient or persistent ST-segment depression. They were randomized to abciximab bolus and 24-hour infusion, abciximab bolus and 48-hour infusion, or matching placebo. The overall 1-year mortality rate was 8.3% (649 patients). One-year mortality was 7.8% in the placebo group and 8.2% in the 24-hour and 9.0% in the 48-hour abciximab infusion group. Compared with placebo, the hazard ratio for the 24-hour infusion of abciximab was 1.1 (95% CI 0.86 to 1.29), and for the 48-hour infusion, it was 1.2 (95% CI 0.95 to 1.41). The lack of benefit of abciximab was observed in every subgroup studied. Patients with negative troponin or elevated C-reactive protein had a higher mortality rate after treatment with abciximab for 48 hours than with placebo: 8.5% versus 5.8% in those with negative troponin (P=0.02), 16.3% versus 12.1% in those with elevated C-reactive protein (P=0.04). CONCLUSIONS: Compared with placebo, abciximab did not provide any survival benefit at 1 year in patients admitted with an acute coronary syndrome with ST depression and/or elevated troponin who were not scheduled to undergo early coronary revascularization. In subgroups of patients, in particular those with low cardiac troponin or elevated C-reactive protein, abciximab was associated with excess mortality
Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes.
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 coronar
Association between minor elevations of creatine kinase-MB level and mortality in patients with acute coronary syndromes without ST-segment elevation.
CONTEXT: Controversy surrounds the diagnostic and prognostic importance of
slightly elevated cardiac markers in patients with acute coronary
syndromes without ST-segment elevation. OBJECTIVES: To investigate the
relationship between peak creatine kinase (CK)-MB level and outcome and to
determine whether a threshold CK-MB level exists below which risk is not
increased. DESIGN AND SETTING: Retrospective observational analysis of
data from the international Platelet Glycoprotein IIb/IIIa in Unstable
Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial,
conducted from November 1995 to January 1997. PATIENTS: A total of 8250
patients with acute coronary syndromes without ST-segment elevation who
had at least 1 CK-MB sample collected during their index hospitalization.
MAIN OUTCOME MEASURE: Mortality at 30 days and 6 months, was assessed by
category of index-hospitalization peak CK-MB level (0-1, >1-2, >2-3, >3-5,
>5-10, or >10 times the upper limit of normal). Multivariable logistic
regression was used to determine the independent prognostic significance
of peak CK-MB level after adjustment for baseline predictors of 30-day and
6-month mortality. RESULTS: Mortality at 30 days and 6 months increased
from 1.8% and 4.0%, respectively, in patients with normal peak CK-MB
levels, to 3.3% and 6.2 % at peak CK-MB levels 1 to 2 times normal, to
5.1% and 7.5% at peak CK-MB levels 3 to 5 times normal, and to 8.3% and
11.0% at peak CK-MB levels greater than 10 times normal. Log-transformed
peak CK-MB levels were predictive of adjusted 30-day and 6-month mortality
(P<.001 for both). CONCLUSIONS: Our data show that elevation of CK-MB
level is strongly related to mortality in patients with acute coronary
syndromes without ST-segment elevation, and that the increased risk begins
with CK-MB levels just above normal. In the appropriate clinical context,
even minor CK-MB elevations should be considered indicative of myocardial
infarction
Clinical and therapeutic profile of patients presenting with acute coronary syndromes who do not have significant coronary artery disease.The Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial Investigators
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 RESULTS: Of the 5767 patients with
non-ST-segment elevation ACS who were enrolled in the Platelet
Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using
Integrilin (Eptifibatide) Therapy (PURSUIT) trial and who underwent
in-hospital angiography, 88% had significant CAD (any stenosis >50%), 6%
had mild CAD (any stenosis >0% to </=50%), and 6% had no CAD (no stenosis
identified). The frequency of death or nonfatal myocardial infarction at
30 days was reduced with eptifibatide treatment in patients with
significant CAD (18.3% versus 15.6% for placebo, P=0.006) but not in those
with mild CAD (6.6% versus 5.4%, P=0.62) and with no CAD (3.0% versus 1.
2%, P=0.28). We identified independent baseline predictors of
insignificant CAD (mild or no CAD) and used them to develop a simple
predictive nomogram of the probability of insignificant CAD for use at
hospital presentation. This nomogram was validated in a separate
population of patients with non-ST-segment elevation ACS. CONCLUSIONS:
Patients with suspected ACS found to have insignificant CAD have a low
risk of adverse outcomes, do not appear to benefit from treatment with
eptifibatide, and can be predicted with a simple nomogram drawn from
baseline characteristics. Because patients with significant CAD appear to
have an enhanced benefit from eptifibatide treatment, the predictive
nomogram developed can be used to determine indications for glycoprotein
IIb/IIIa blockade