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1.

001-es BibID:BIBFORM010423
Első szerző:Jones, Robert H.
Cím:Coronary bypass surgery with or without surgical ventricular reconstruction / Robert H. Jones, Eric J. Velazquez, Robert E. Michler, George Sopko, Jae K. Oh, Christopher M. O'Connor, James A. Hill, Lorenzo Menicanti, Zygmunt Sadowski, Patrice Desvigne-Nickens, Jean-Lucien Rouleau, Kerry L. Lee, The STICH Hypothesis 2 Investigators
Dátum:2009
ISSN:0028-4793 (Print)
Megjegyzések:Surgical ventricular reconstruction is a specific procedure designed to reduce left ventricular volume in patients with heart failure caused by coronary artery disease. We conducted a trial to address the question of whether surgical ventricular reconstruction added to coronary-artery bypass grafting (CABG) would decrease the rate of death or hospitalization for cardiac causes, as compared with CABG alone. METHODS: Between September 2002 and January 2006, a total of 1000 patients with an ejection fraction of 35% or less, coronary artery disease that was amenable to CABG, and dominant anterior left ventricular dysfunction that was amenable to surgical ventricular reconstruction were randomly assigned to undergo either CABG alone (499 patients) or CABG with surgical ventricular reconstruction (501 patients). The primary outcome was a composite of death from any cause and hospitalization for cardiac causes. The median follow-up was 48 months. RESULTS: Surgical ventricular reconstruction reduced the end-systolic volume index by 19%, as compared with a reduction of 6% with CABG alone. Cardiac symptoms and exercise tolerance improved from baseline to a similar degree in the two study groups. However, no significant difference was observed in the primary outcome, which occurred in 292 patients (59%) who were assigned to undergo CABG alone and in 289 patients (58%) who were assigned to undergo CABG with surgical ventricular reconstruction (hazard ratio for the combined approach, 0.99; 95% confidence interval, 0.84 to 1.17; P=0.90). CONCLUSIONS: Adding surgical ventricular reconstruction to CABG reduced the left ventricular volume, as compared with CABG alone. However, this anatomical change was not associated with a greater improvement in symptoms or exercise tolerance or with a reduction in the rate of death or hospitalization for cardiac causes.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Aged
Coronary Artery Bypass
Coronary Disease
Female
Follow-Up Studies
Heart Failure
Heart Ventricles
Hospitalization
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Mortality
Patient Selection
Stroke Volume
Treatment Outcome
Ventricular Dysfunction, Left
Ventricular Remodeling
Megjelenés:The New England Journal of Medicine. - 360 : 17 (2009), p. 1705-1717. -
További szerzők:Velazquez, Eric J. Michler, Robert E. Sopko, George Oh, Jae K. O'Connor, Christopher M. Hill, James A. Menicanti, Lorenzo Sadowski, Zygmunt Desvigne-Nickens, Patrice Rouleau, Jean-Lucien Lee, Kerry L. Édes István (1952-) (kardiológus) The STICH Hypothesis 2 Investigators
Internet cím:Intézményi repozitóriumban (DEA) tárolt változat
DOI
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2.

001-es BibID:BIBFORM005636
Első szerző:Massie, Barry M.
Cím:Irbesartan in patients with heart failure and preserved ejection fraction / Massie, B. M., Carson, P. E., McMurray, J. J., Komajda, M., McKelvie, R., Zile, M. R., Anderson, S., Donovan, M., Iverson, E., Staiger, C., Ptaszynska, A., The I-PRESERVE Investigators
Dátum:2008
ISSN:1533-4406 (Electronic)
Megjegyzések:Approximately 50% of patients with heart failure have a left ventricular ejection fraction of at least 45%, but no therapies have been shown to improve the outcome of these patients. Therefore, we studied the effects of irbesartan in patients with this syndrome. METHODS: We enrolled 4128 patients who were at least 60 years of age and had New York Heart Association class II, III, or IV heart failure and an ejection fraction of at least 45% and randomly assigned them to receive 300 mg of irbesartan or placebo per day. The primary composite outcome was death from any cause or hospitalization for a cardiovascular cause (heart failure, myocardial infarction, unstable angina, arrhythmia, or stroke). Secondary outcomes included death from heart failure or hospitalization for heart failure, death from any cause and from cardiovascular causes, and quality of life. RESULTS: During a mean follow-up of 49.5 months, the primary outcome occurred in 742 patients in the irbesartan group and 763 in the placebo group. Primary event rates in the irbesartan and placebo groups were 100.4 and 105.4 per 1000 patient-years, respectively (hazard ratio, 0.95; 95% confidence interval [CI], 0.86 to 1.05; P=0.35). Overall rates of death were 52.6 and 52.3 per 1000 patient-years, respectively (hazard ratio, 1.00; 95% CI, 0.88 to 1.14; P=0.98). Rates of hospitalization for cardiovascular causes that contributed to the primary outcome were 70.6 and 74.3 per 1000 patient-years, respectively (hazard ratio, 0.95; 95% CI, 0.85 to 1.08; P=0.44). There were no significant differences in the other prespecified outcomes. CONCLUSIONS: Irbesartan did not improve the outcomes of patients with heart failure and a preserved left ventricular ejection fraction.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Adrenergic beta-Antagonists/therapeutic use
Aged
Angiotensin II Type 1 Receptor Blockers/adverse effects/ therapeutic use
Angiotensin-Converting Enzyme Inhibitors/therapeutic use
Biphenyl Compounds/adverse effects/ therapeutic use
Cardiovascular Diseases/epidemiology/mortality
Drug Therapy, Combination
Female
Follow-Up Studies
Heart Failure/ drug therapy/mortality/physiopathology
Hospitalization/statistics & numerical data
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Proportional Hazards Models
Quality of Life
Stroke Volume
Tetrazoles/adverse effects/ therapeutic use
Treatment Failure
Megjelenés:The New England Journal of Medicine. - 359 : 23 (2008), p. 2456-2467. -
További szerzők:Carson, Peter E. McMurray, John J. Komajda, Michel McKelvie, Robert Zile, Michael R. Anderson, Susan Donovan, Mark Iverson, Erik Staiger, Christoph Ptaszynska, Agata Édes István (1952-) (kardiológus) The I-PRESERVE Investigators
Internet cím:DOI
elektronikus változat
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3.

001-es BibID:BIBFORM010426
Első szerző:Serruys, Patrick W.
Cím:Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease / Patrick W. Serruys, Marie-Claude Morice, A. Pieter Kappetein, Antonio Colombo, David R. Holmes, Michael J. Mack, Elisabeth Stähle, Ted E. Feldman, Marcel van den Brand, Eric J. Bass, Nic Van Dyck, Katrin Leadley, Keith D. Dawkins, Friedrich W. Mohr, The SYNTAX Investigators
Dátum:2009
ISSN:0028-4793 (Print)
Megjegyzések:Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both). METHODS: We randomly assigned 1800 patients with three-vessel or left main coronary artery disease to undergo CABG or PCI (in a 1:1 ratio). For all these patients, the local cardiac surgeon and interventional cardiologist determined that equivalent anatomical revascularization could be achieved with either treatment. A noninferiority comparison of the two groups was performed for the primary end point--a major adverse cardiac or cerebrovascular event (i.e., death from any cause, stroke, myocardial infarction, or repeat revascularization) during the 12-month period after randomization. Patients for whom only one of the two treatment options would be beneficial, because of anatomical features or clinical conditions, were entered into a parallel, nested CABG or PCI registry. RESULTS: Most of the preoperative characteristics were similar in the two groups. Rates of major adverse cardiac or cerebrovascular events at 12 months were significantly higher in the PCI group (17.8%, vs. 12.4% for CABG; P=0.002), in large part because of an increased rate of repeat revascularization (13.5% vs. 5.9%, P<0.001); as a result, the criterion for noninferiority was not met. At 12 months, the rates of death and myocardial infarction were similar between the two groups; stroke was significantly more likely to occur with CABG (2.2%, vs. 0.6% with PCI; P=0.003). CONCLUSIONS: CABG remains the standard of care for patients with three-vessel or left main coronary artery disease, since the use of CABG, as compared with PCI, resulted in lower rates of the combined end point of major adverse cardiac or cerebrovascular events at 1 year.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Cardiovascular Diseases
Coronary Artery Bypass
Coronary Artery Disease
Drug-Eluting Stents
Female
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Myocardial Infarction
Prospective Studies
Retreatment
numerical data
Severity of Illness Index
Stroke
Treatment Outcome
Megjelenés:The New England Journal of Medicine. - 360 : 10 (2009), p. 961-972. -
További szerzők:Morice, Marie-Claude Kappetein, Arie Pieter Colombo, Antonio Holmes, David R. Mack, Michael J. Stähle, Elisabeth Feldman, Ted E. Brand, Marcel, van den Bass, Eric J. Dyck, Nic, Van Leadley, Katrin Dawkins, Keith D. Mohr, Friedrich Wilhelm Édes István (1952-) (kardiológus) The SYNTAX Investigators
Internet cím:DOI
Intézményi repozitóriumban (DEA) tárolt változat
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4.

001-es BibID:BIBFORM010427
Első szerző:Steinbeck, Gerhard
Cím:Defibrillator implantation early after myocardial infarction / Gerhard Steinbeck, Dietrich Andresen, Karlheinz Seidl, Johannes Brachmann, Ellen Hoffmann, Dariusz Wojciechowski, Zdzislawa Kornacewicz-Jach, Beata Sredniawa, Géza Lupkovics, Franz Hofgärtner, Andrzej Lubinski, Marten Rosenqvist, Alphonsus Habets, Karl Wegscheider, Jochen Senges, The IRIS Investigators
Dátum:2009
ISSN:0028-4793 (Print)
Megjegyzések:The rate of death, including sudden cardiac death, is highest early after a myocardial infarction. Yet current guidelines do not recommend the use of an implantable cardioverter-defibrillator (ICD) within 40 days after a myocardial infarction for the prevention of sudden cardiac death. We tested the hypothesis that patients at increased risk who are treated early with an ICD will live longer than those who receive optimal medical therapy alone. METHODS: This randomized, prospective, open-label, investigator-initiated, multicenter trial registered 62,944 unselected patients with myocardial infarction. Of this total, 898 patients were enrolled 5 to 31 days after the event if they met certain clinical criteria: a reduced left ventricular ejection fraction (< or = 40%) and a heart rate of 90 or more beats per minute on the first available electrocardiogram (ECG) (criterion 1: 602 patients), nonsustained ventricular tachycardia (> or = 150 beats per minute) during Holter monitoring (criterion 2: 208 patients), or both criteria (88 patients). Of the 898 patients, 445 were randomly assigned to treatment with an ICD and 453 to medical therapy alone. RESULTS: During a mean follow-up of 37 months, 233 patients died: 116 patients in the ICD group and 117 patients in the control group. Overall mortality was not reduced in the ICD group (hazard ratio, 1.04; 95% confidence interval [CI], 0.81 to 1.35; P=0.78). There were fewer sudden cardiac deaths in the ICD group than in the control group (27 vs. 60; hazard ratio, 0.55; 95% CI, 0.31 to 1.00; P=0.049), but the number of nonsudden cardiac deaths was higher (68 vs. 39; hazard ratio, 1.92; 95% CI, 1.29 to 2.84; P=0.001). Hazard ratios were similar among the three groups of patients categorized according to the enrollment criteria they met (criterion 1, criterion 2, or both). CONCLUSIONS: Prophylactic ICD therapy did not reduce overall mortality among patients with acute myocardial infarction and clinical features that placed them at increased risk.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Aged
Cause of Death
Death, Sudden, Cardiac
control
Defibrillators, Implantable
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction
Proportional Hazards Models
Registries
Risk
Survival Rate
Time Factors
Megjelenés:The New England Journal of Medicine. - 361 : 15 (2009), p. 1427-1436. -
További szerzők:Andresen, Dietrich Seidl, Karlheinz Brachmann, Johannes Hoffmann, Ellen Wojciechowski, Dariusz Kornacewicz-Jach, Zdzislawa Sredniawa, Beata Lupkovics Géza Hofgärtner, Franz Lubinski, Andrzej Rosenqvist, Marten Habets, Alphonsus Wegscheider, Karl Senges, Jochen Édes István (1952-) (kardiológus) Kolozsvári Rudolf (1976-) (kardiológus) The IRIS Investigators
Internet cím:Intézményi repozitóriumban (DEA) tárolt változat
DOI
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5.

001-es BibID:BIBFORM005644
Első szerző:Yusuf, Salim (belgyógyász)
Cím:Telmisartan, ramipril, or both in patients at high risk for vascular events / Yusuf, S., Teo, K. K., Pogue, J., Dyal, L., Copland, I., Schumacher, H., Dagenais, G., Sleight, P., Anderson, C., The Ontarget Investigators
Dátum:2008
ISSN:1533-4406 (Electronic)
Megjegyzések:In patients who have vascular disease or high-risk diabetes without heart failure, angiotensin-converting-enzyme (ACE) inhibitors reduce mortality and morbidity from cardiovascular causes, but the role of angiotensin-receptor blockers (ARBs) in such patients is unknown. We compared the ACE inhibitor ramipril, the ARB telmisartan, and the combination of the two drugs in patients with vascular disease or high-risk diabetes. METHODS: After a 3-week, single-blind run-in period, patients underwent double-blind randomization, with 8576 assigned to receive 10 mg of ramipril per day, 8542 assigned to receive 80 mg of telmisartan per day, and 8502 assigned to receive both drugs (combination therapy). The primary composite outcome was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for heart failure. RESULTS: Mean blood pressure was lower in both the telmisartan group (a 0.9/0.6 mm Hg greater reduction) and the combination-therapy group (a 2.4/1.4 mm Hg greater reduction) than in the ramipril group. At a median follow-up of 56 months, the primary outcome had occurred in 1412 patients in the ramipril group (16.5%), as compared with 1423 patients in the telmisartan group (16.7%; relative risk, 1.01; 95% confidence interval [CI], 0.94 to 1.09). As compared with the ramipril group, the telmisartan group had lower rates of cough (1.1% vs. 4.2%, P<0.001) and angioedema (0.1% vs. 0.3%, P=0.01) and a higher rate of hypotensive symptoms (2.6% vs. 1.7%, P<0.001); the rate of syncope was the same in the two groups (0.2%). In the combination-therapy group, the primary outcome occurred in 1386 patients (16.3%; relative risk, 0.99; 95% CI, 0.92 to 1.07); as compared with the ramipril group, there was an increased risk of hypotensive symptoms (4.8% vs. 1.7%, P<0.001), syncope (0.3% vs. 0.2%, P=0.03), and renal dysfunction (13.5% vs. 10.2%, P<0.001). CONCLUSIONS: Telmisartan was equivalent to ramipril in patients with vascular disease or high-risk diabetes and was associated with less angioedema. The combination of the two drugs was associated with more adverse events without an increase in benefit.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Aged
Angioedema
Angiotensin II Type 1 Receptor Blockers
Benzimidazoles
Benzoates/adverse effects
Blood Pressure
Cardiovascular Diseases
Creatinine
Diabetes Mellitus
Double-Blind Method
Drug Therapy, Combination
Female
Follow-Up Studies
Hospitalization
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Ramipril
Risk
Megjelenés:The New England Journal of Medicine. - 358 : 15 (2008), p. 1547-1559. -
További szerzők:Teo, K. K. Pogue, J. Dyal, L. Copland, I. Schumacher, H. Dagenais, G. Sleight, Peter Anderson, C. Édes István (1952-) (kardiológus) Czuriga István (1948-2018) (kardiológus) The Ontarget Investigators
Internet cím:Letölthető pdf
elektronikus változat
DOI
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6.

001-es BibID:BIBFORM029346
Cím:Comparison of fondaparinux and enoxaparin in acute coronary syndromes / The Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators
Dátum:2006
ISSN:0028-4793
Megjegyzések:The combined use of anticoagulants, antiplatelet agents, and invasive coronary procedures reduces ischemic coronary events but also increases bleeding in patients with acute coronary syndromes. We therefore assessed whether fondaparinux would preserve the anti-ischemic benefits of enoxaparin while reducing bleeding. METHODS: We randomly assigned 20,078 patients with acute coronary syndromes to receive either fondaparinux (2.5 mg daily) or enoxaparin (1 mg per kilogram of body weight twice daily) for a mean of six days and evaluated death, myocardial infarction, or refractory ischemia at nine days (the primary outcome); major bleeding; and their combination. Patients were followed for up to six months. RESULTS: The number of patients with primary-outcome events was similar in the two groups (579 with fondaparinux [5.8 percent] vs. 573 with enoxaparin [5.7 percent]; hazard ratio in the fondaparinux group, 1.01; 95 percent confidence interval, 0.90 to 1.13), satisfying the noninferiority criteria. The number of events meeting this combined outcome showed a nonsignificant trend toward a lower value in the fondaparinux group at 30 days (805 vs. 864, P=0.13) and at the end of the study (1222 vs. 1308, P=0.06). The rate of major bleeding at nine days was markedly lower with fondaparinux than with enoxaparin (217 events [2.2 percent] vs. 412 events [4.1 percent]; hazard ratio, 0.52; P<0.001). The composite of the primary outcome and major bleeding at nine days favored fondaparinux (737 events [7.3 percent] vs. 905 events [9.0 percent]; hazard ratio, 0.81; P<0.001). Fondaparinux was associated with a significantly reduced number of deaths at 30 days (295 vs. 352, P=0.02) and at 180 days (574 vs. 638, P=0.05). CONCLUSIONS: Fondaparinux is similar to enoxaparin in reducing the risk of ischemic events at nine days, but it substantially reduces major bleeding and improves long term mortality and morbidity.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:The New England Journal of Medicine 354 : 14 (2006), p. 1464-1476. -
További szerzők:Csiba László (1952-) (neurológus, pszichiáter) Édes István (1952-) (kardiológus) The Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators
Internet cím:DOI
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