Working Paper

To educate students for a lifetime of contribution to society, colleges and universities accept an enormous challenge. Toward this end, they help students pursue a broad range of goals-prepare for careers, acquire a sense of civic responsibility; gain self-awareness, and learn how to learn

Mechanism of benefit of combination thrombolytic therapy for acute myocardial infarction: A quantitative angiographic and hematologic study

AbstractObjectives. The goal of this study was to lend insight into the mechanisms responsible for the beneficial effects of combination thrombolytic therapy.Background. Combination thrombolytic therapy for acute myocardial infarction bas been associated with less reocclusion and fewer in-hospital clinical events than has monotherapy.Methods. Infarct-related quantitative coronary dimensions and hemostatic protein levels were evaluated in 287 patients with acute myocardial infarction during the early (90-min) and convalescent (7-day) phases after administration of recombinant tissue-type plasminogen activator (rt-PA), urokinase or combination rt-PA and urokinase.Results. Minimal lumen diameter was similar in the 90-min and 7-day phases after treatment with rt-PA, urokinase and combination rt-PA and urokinase (0.72 ± 0.45 mm, 0.62 ± 0.53 mm and 0.75 ± 0.58 mm, respectively, at 90 min, p = 0.16; and 1.05 ± 0.56 mm, 1.12 ± 0.72 mm and 0.94 ± 0.54 mm, respectively, at 7 days, p = 0.22). In-hospital clinical event and reocclusion rates were less frequent in patients receiving combination therapy than in those receiving monotherapy (25% vs. 38% and 32% for rt-PA and urokinase, respectively, p = 0.084; and 3% vs. 13% and 9% for rt-PA and urokinase, respectively, p = 0.03), but these events were unrelated to early or late coronary dimensions. Patients receiving combination therapy or urokinase monotherapy had significantly higher peak fibrin degradation products (1,307 ± 860 and 1,285 ± 898 μg/ml vs. 435 ± 717 μg/ml, respectively, p < 0.0001) and lower nadir fibrinogen levels (0.85 ± 1.00 and 0.75 ± 0.53 g/liter vs. 1.90 ± 0.86 g/liter, respectively, p < 0.0001) than did those receiving rt-PA monotherapy. Peak fibrinogen degradation products indirectly correlated (p = 0.004) and baseline (p = 0.026) and nadir (p = 0.089) fibrinogen levels directly correlated with reocclusion.Conclusions. Lower in-hospital clinical event and reocclusion rates observed with combination thrombolytic therapy may relate to systemic hematologic factors rather than to the residual lumen obstruction after thrombolysis

Re-engaging a Pioneer: Robert L. Sigmon and Service-Learning Roots

Robert L. Sigmon invested a career in building quality experiential education and service-learning. Upon contributing his "library" to Elon University, Partnerships engaged him in conversation about his work, and rich legacy to the field. In this article, we re-introduce this pioneer, review his work, and hear his ongoing challenge to the field. Partnerships encourages researchers today to access the archives at Elon to expand service-learning research.KEYWORDSservice-learning; community partnerships; service-learning pioneers; community engagemen

Multivessel coronary artery disease: A key predictor of short-term prognosis after reperfusion therapy for acute myocardial infarction

Results of recent studies have suggested that routine cardiac catheterization may be unnecessary after reperfusion therapy for acute myocardial infarction. Therefore to better define the short-term prognostic value of early coronary angiography, and specifically the prognostic significance of multivessel coronary artery disease, the angiographic findings of 855 patients consecutively enrolled in five phases of the TAMI study were correlated with their in-hospital outcome. All patients received intravenous thrombolytic therapy (tissue plasminogen activator, urokinase, or both agents) and underwent cardiac catheterization within 90 minutes of the initiation of therapy. Multivessel disease, defined as the presence of &gt;= 75% luminal diameter stenosis in two or more major epicardial arteries, was documented in 236 patients. When compared with the group of patients without multivessel disease, this group had a higher prevalence of coronary risk factors and more frequently had a history of antecedent ischemic chest pain. Although the severity of the infarct zone dysfunction was similar in the two groups (-2.77 +/- 1.00 vs -2.50 +/- 1.09 SD/chord, p = NS), global left ventricular ejection fraction was lower in the group with multivessel disease (48.6 +/- 12.4% vs 51.8 +/- 10.6%, p p = 0.0001). The in-hospital mortality rate, predominantly the result of myocardial failure and cardiogenic shock, was also significantly higher in the multivessel group (11.4% vs 4.2%, p p p = 0.01), TIMI grade infarct vessel flow (p = 0.03), and patient age (p = 0.03). According to this model the prognostic significance of one additional year of age was equivalent to a reduction in left ventricular function of 1.1 ejection fraction percentage points; one additional diseased vessel was equivalent to 15 additional years of age or a reduction in ejection fraction of 16 percentage points. These data suggest that more aggressive revascularization procedures should be considered in the early postinfarction period for patients with multivessel disease and noninfarct zone dysfunction. In the absence of reliable noninvasive techniques, coronary angiography remains the procedure of choice for identifying this high-risk subgroup.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29410/1/0000484.pd