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1. Pattern of acute MI admissions in India during COVID-19 era: A Cardiological Society of India study - Rationale and design

Author

Sivasubramanian Ramakrishnan, Abdullakutty Jabir, Pathiyil Balagopalan Jayagopal, Padinhare Purayil Mohanan, Venugopal Krishnan Nair, Mrinal Kanti Das, Manoranjan Mandal, Debabrata Roy, Seemala Saikrishna Reddy, Amit Malviya, Bateshwar Prasad Singh, Bishwa Bhushan Bharti, Biswajit Majumder, Chakkalakkal Prabhakaran Karunadas, Chandra Bhan Meena, Meennahalli Palleda Girish, Janakiraman Ezhilan, Karthik Tummala, Virender Kumar Katyal, Kodangala Subramanyam, Krishna Kishore Goyal, Kumar Kenchappa, Mohit Dayal Gupta, Natesh Bangalore Hanumanthappa, Neil Bardoloi, Nitin Modi, Pranab Jyoti Bhattacharyya, Pushkraj Gadkari, Rahul Raosaheb Patil, Rambhatla Suryanarayana Murty, Rituparna Baruah, Santhosh Krishnappa, Satish Kumar, Satyanarayan Routray, Satyendra Tewari, Shashi Bhushan Gupta, Sivabalan Maduramuthu, Sreekanth Yerram, Sudeep Kumar, Uday Jadhav, Cholenahally Nanjappa Manjunath, Dorairaj Prabhakaran, Prafulla Kerker, Rakesh Yadav, Santanu Guha, Pradip Kumar Deb, and Geevar Zachariah

Subjects
Acute coronary syndrome, Acute myocardial infarction, Corona virus, COVID-19, Outcome, Surgery, RD1-811, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. Methods: In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. Conclusions: This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.

Published
2020
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2. Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic

Author

Tom Devasia, Katyal Virender Kumar, Mrinal Kanti Das, Sreekanth Yerram, Narendranath Khanna, Nitish Naik, Geevar Zachariah, Swaminathan Nagarajan, Amal Kumar Khan, Neil Bardoloi, Pushkraj Gadkari, Gurpreet Singh Wander, Debabrata Roy, Kewal C. Goswami, Anshul Gupta, Bishav Mohan, Lekha Pathak, Cibu Mathew, Nitin Modi, Dipak Ranjan Das, Krishna Kishore Goyal, Bivin Wilson, Satyanarayan Routray, Venugopal Krishnan Nair, Shashi Bhushan Gupta, Chakkalakkal Prabhakaran Karunadas, Biswajit Majumder, Satyendra Tiwari, Sivabalan Maduramuthu, Rakesh Gupta, P.P. Mohanan, Kalaivani Mani, J. Ezhilan, Rahul Patil, K.R. Subramanyam, Santanu Guha, Saumitra Ray, Dinesh Choudhary, Rathinavel Sivakumar, Rituparna Baruah, Bishwa Bhushan Bharti, Santhosh Krishnappa, Manish Bansal, Rambhatla Suryanarayana Murty, Uday Jadhav, Prafulla Kerker, Siddiqui Kkh, Bateshwar Prasad Singh, Pradeep K. Hasija, Cholenahally Nanjappa Manjunath, Seemala Saikrishna Reddy, Karthik Tummala, Ashok Goyal, Natesh Bangalore Hanumanthappa, Sudeep Kumar, Ramakrishnan Sivasubramanian, Shashi Shekhar Chatterjee, Varun Shankar Narain, Diapk Sarma, Vitull K. Gupta, Sharad Chandra, Harsh Wardhan, Jayagopal Pathiyil Balagopalan, Rakesh Yadav, Girish Meennahalli Palleda, Vijay Kumar Garg, Pradip Kumar Deb, Sanjay Tyagi, C. B. Meena, Amit Malviya, Rishi Sethi, Ranjit Kumar Nath, Dorairaj Prabhakaran, Rabindra Nath Chakraborthy, A. Jabir, Pranab Jyoti Bhattacharyya, Manoranjan Mandal, Satish Kumar, Kumar Kenchappa, and Mohit Gupta

Subjects
Male, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, Logistic regression, Ventricular Function, Left, 0302 clinical medicine, Pandemic, 030212 general & internal medicine, Myocardial infarction, Non-ST Elevated Myocardial Infarction, Mortality rate, Middle Aged, Low-and middle-income country, Acute myocardial infarction (AMI), Patient volume, Non ST elevation Myocardial infarction (NSTEMI) and outcome, Female, Original Article, Acute coronary syndrome, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), RD1-811, India, COVID-19 pandemic, 03 medical and health sciences, LMIC, Percutaneous Coronary Intervention, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, Pandemics, Management practices, Aged, business.industry, COVID-19, Percutaneous coronary intervention, Stroke Volume, medicine.disease, Cross-Sectional Studies, RC666-701, Communicable Disease Control, Time course, Emergency medicine, ST Elevation Myocardial Infarction, Surgery, business, ST elevation Myocardial infarction (STEMI), Demography
Abstract

Background: Admissions for acute myocardial infarction (MI) have declined significantly during the COVID-19 pandemic. The changes in the presentation, management, and outcomes of MI during the pandemic period are not well recognized, and data from low- and middle-income countries are limited. Methods: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with MI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We sought to determine the changes in the number of admissions, management practices, and outcomes. Findings: We included 41,832 consecutive adults with MI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India with the North zone reporting greater decline (-44·8%) than the South zone (-27·7%). The weekly average decrease in MI admissions in 2020 which peaked around the mid- study period, correlated negatively with the number of COVID cases (r = -0·48; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume, and teaching programs. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. However, the in-hospital mortality rates did not differ. Interpretation: The magnitude of reduction in MI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing MI admissions during the pandemic. Funding Statement: The study is funded by cardiological society of India. Declaration of Interests: Nothing to declare for all the authors. Ethics Approval Statement: Individual participating centres either obtained an ethical approval from respective Institutional ethics committees or a no objection certificate from the administration.

Published
2021

3. Pattern of acute MI admissions in India during COVID-19 era: A Cardiological Society of India study - Rationale and design

Author

J. Ezhilan, Venugopal Krishnan Nair, Chakkalakkal Prabhakaran Karunadas, Uday Jadhav, Dorairaj Prabhakaran, Sivabalan Maduramuthu, A. Jabir, Biswajit Majumder, Satish Kumar, Debabrata Roy, Sivasubramanian Ramakrishnan, Pranab Jyoti Bhattacharyya, Mohit Gupta, Karthik Tummala, Krishna Kishore Goyal, M.P. Girish, Satyanarayan Routray, Bishwa Bhushan Bharti, Pushkraj Gadkari, Kumar Kenchappa, Nitin Modi, Bateshwar Prasad Singh, Manoranjan Mandal, K.R. Subramanyam, C. B. Meena, Rituparna Baruah, P.P. Mohanan, Cholenahally Nanjappa Manjunath, Natesh Bangalore Hanumanthappa, Santanu Guha, P.B. Jayagopal, Rambhatla Suryanarayana Murty, Satyendra Tewari, Seemala Saikrishna Reddy, Amit Malviya, Santhosh Krishnappa, Geevar Zachariah, V.K. Katyal, Pradip Kumar Deb, Rakesh Yadav, Sreekanth Yerram, Mrinal Kanti Das, Sudeep Kumar, Neil Bardoloi, Prafulla Kerker, Rahul Patil, and Shashi Bhushan Gupta

Subjects
Male, GCP, good clinical practice, Cross-sectional study, Myocardial Infarction, Comorbidity, 030204 cardiovascular system & hematology, 0302 clinical medicine, Patient Admission, Pandemic, 030212 general & internal medicine, Societies, Medical, Outcome, Incidence (epidemiology), Mortality rate, Incidence, Female, Original Article, Acute coronary syndrome, Cardiology and Cardiovascular Medicine, Emergency Service, Hospital, Adult, medicine.medical_specialty, Corona virus, RD1-811, Cardiology, India, Acute myocardial infarction, ACS, Acute coronary syndrome, 03 medical and health sciences, STEMI, ST elevation myocardial infarction, medicine, Diseases of the circulatory (Cardiovascular) system, Humans, cardiovascular diseases, Pandemics, Retrospective Studies, business.industry, SARS-CoV-2, COVID-19, Retrospective cohort study, ICMR, Indian council of medical research, medicine.disease, CSI, cardiology society of India, AMI, acute myocardial infarction, Cross-Sectional Studies, RC666-701, COVID 19, corona virus disease of 2019, Emergency medicine, Door-to-balloon, Observational study, Surgery, NSTEMI, non-STEMI, business
Abstract

Background COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. Methods In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. Conclusions This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.

Published
2020

4. Cardiological Society of India Document on Safety Measure During Echo Evaluation of Cardiovascular Disease in the Time of COVID-19

Author

Ravi R Kasliwal, Prafulla Kerkar, Narendra N. Khanna, P.P. Mohanan, P.B. Jayagopal, A.L. Dutta, Bateshwar Prasad Singh, V. Jain, Sachin Tyagi, K. Raghu, Santanu Guha, V.K. Katyal, Mrinal Kanti Das, Gurpreet Singh Wander, Manoranjan Mandal, H K Chopra, Nandita Chakraborti, Rakesh K. Gupta, Ashok Garg, Debabrata Roy, Pradeep K. Hasija, A.K. Pancholia, Rakesh Yadav, D. Chatterjee, Pradip K. Deb, Nitish Naik, S.C. Govind, Varun Shankar Narain, Saumitra Ray, Lekha Pathak, P. Jain, G. Vijayaraghavan, S K Parashar, C. B. Meena, N.K. Goyal, C.K. Ponde, Amal Kumar Khan, R.N. Chakraborty, Biswajit Majumder, R. Alagesan, Navin C. Nanda, Sharad Chandra, Manish Bansal, A. Chatterjee, Sameer Shrivastava, Ashok Goyal, Kewal C. Goswami, V. Amuthan, Vijay Kumar Garg, Vitull K. Gupta, Sundeep Mishra, S. Shanmugasundarum, A. Jabir, Harsh Wardhan, A. De, D. D. Sarma, and Shelly Chatterjee

Subjects
Male, MERS, Middle East Respiratory Syndrome, AP2C view, Apical 2 chamber view, Disease, 030204 cardiovascular system & hematology, Severe Acute Respiratory Syndrome, ICMR, Indian Council of Medical Research, 0302 clinical medicine, Echo, Echocardiography, CVD, Cardiovascular disease, IVC Dynamic view, Inferior Vena Cava dynamic view, SARS, Severe Acute Respiratory Syndrome, ACE2, Angiotensin Converting Enzyme 2, Cardiological Society of India, CFM, Color Flow Mapping, 030212 general & internal medicine, PSAX view, parasternal short axis view, Societies, Medical, Cross Infection, PAT, Pulmonary artery acceleration time, ECG, Electrocardiogram, Echo (computing), CT, Computed Tomography, ICU, Intensive care unit, Cardiovascular Diseases, Echocardiography, PPE, Personal Protection Equipment, Practice Guidelines as Topic, Female, Medical emergency, Patient Safety, Cardiology and Cardiovascular Medicine, Coronavirus Infections, GSM, Gram per square meter, COVID -19, Coronavirus disease 2019 (COVID-19), RD1-811, HCQS, Hydroxychloroqine sulfate, Pneumonia, Viral, Cardiology, India, Safety measures, Article, 03 medical and health sciences, Patient safety, PLAX view, Parasternal long axis view, LVOT CW trace, Left ventricular outflow tract Continuous Wave trace, AP4C view, Apical 4 Chamber view, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, In patient, Pandemics, Infection Control, Modalities, Health professionals, business.industry, Cardiovascular evaluation, COVID-19, DM, Diabetes mellitus, medicine.disease, Comorbidity, TEE, Transesophageal Echo, HCW, Health Care Workers, CI, Confidence Interval, RV Focussed view, Right ventricle Focussed view, COVID-19, Coronavirus disease -19, HTN, hypertension, RC666-701, Surgery, business, NHC, National Health Commission, TR jet velocity, Tricuspid regurgitation jet velocity
Abstract

An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-a-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.

Published
2020

5. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization

Author

L. Wang, T. Stys, William E. Boden, R. H. Urbano, D. M. Olinic, Karen S. Pieper, A. Kuijper, E. Soh, J. Nicolau, Jadwiga Nessler, William J. Rogers, Ernesto Rivera, R. Braam, H. Kadr, J. Csikasz, B. Boichev, Prafulla Kerkar, I. Kraiz, R. Babu, Ali Aydinlar, D. Safley, O. Nguyen-Khac, P. Chua, W. Buchanan, C. A. Morales, A. Abyankar, A. Srinivas, S. Genth-Zotz, J. Rocha Faria Neto, D. Drenning, L. Moretti, S. Varma, D. Roth, C. Matei, Jane E. Onken, H. Tumbev, P. Keeling, Xian Li, N. Ciglenecki, Shahyar M. Gharacholou, P. P. Goh, D. Sporn, M. Chang, Marcin Gruchała, R. Foreman, Bogdan Minescu, S. Nawaz, N. Alexeeva, Y. Shalev, C. Fastabend, L. van Zyl, J. F. Certic, J. Longo, J. Wang, K. Dave, Olivier Morel, F. Maatouk, Y. El Rakshy, J. Giacomini, P. Lazov, R. Marino, Dimitar Raev, M. Y. Chan, L. Z. Dextre, Y. Hao, P. Sepulveda, K. Ramshev, C. Bayron, Ameer Kabour, Alon Marmor, Luciano Moreira Baracioli, H. Marais, Rajendra H. Mehta, R. Breedveld, A. Ben Khalfallah, Kurtulus Ozdemir, I. Westendorp, J. A. Quion, Daniel J. George, D. F. Garcia, J.-P Bassand, G. Szalai, Huw Griffiths, O. Ushakov, M. Tzekova, E. Suprun, A. Mowafy, N. El Mansour, Gail V.W. Johnson, Tereshchenko Sn, W. T. Lai, Petr Widimsky, Hany Ragy, V. R. Castillo, M. Padour, Gilles Montalescot, Louie Tirador, Deepak L. Bhatt, M. Marrinan, S. Promisloff, A. Nambiar, Reginald G.E.J. Groutars, S. R. Lee, J. Cabrera, S. Zhang, András Jánosi, K. Wita, R. Sciborski, Annabelle Rodriguez, P. Sedlon, Jaroslaw D. Kasprzak, A. Faynyk, A. Romero Acuña, M. C. Ramirez, Rakesh Gupta, R. Saligrama, Jacek Gniot, Y. Ke, John H. Alexander, X. Liu, E. Baranov, R. Grzywna, Mukul Sharma, A. Linka, Jarosław Wójcik, Haroon Rashid, M. S. Sanchez, M. Gadkari, B. Rao, James S. Zebrack, Paul W. Armstrong, Francois Schiele, Gracita O. Topacio, Peter J. Casterella, A. Belhassane, P. Golino, F. Plat, P. Roberts-Thomson, K. S. Kim, Stephen D. Wiviott, Mathew T. Roe, Y. D. Chen, I. A. Khan, S. Thanvi, S. Isserman, G. Falck, R. M. Coching, S. C. Stamate, M. Ogorek, K. Danisa, Poul Anders Hansen, M. Medvegy, Amos Katz, R. K. Seerangachar, B. Farah, V. Kale, B. Kusnick, Maurice Pye, M. Mosseri, M. Vatutin, D. Weinstein, Norma Keller, A. Mihov, Ewa Mirek-Bryniarska, N. Adjei, S. Sethi, A. Irimpen, M. Broeders, T. Huynh, K. Niezgoda, P. Samardzic, D. Ziperman, Stuart J. Pocock, T. Arad, J. Lewczuk, M. Amuchastegui, R. Moscoso, B. Dimov, W. A. Ahmad, E. Dalli, P. Laothavorn, S. Shaikh, Helmut U. Klein, J. Menon, H. Colombo, L. Fattore, G. Zarrella, Dorairaj Prabhakaran, N. Viboolkitvarakul, Judith D. Goldberg, Neetika Garg, Y. Hasin, F. Rossi Dos Santos, S. J. Vigo, L. Horbach, O. Prokhorov, H. Moellmann, T. R. Vera, C. E. Botta, Domitilla Russo, M. Rossovskaya, David C. Henderson, Rebecca B. Costello, V. Shcherbak, C. J.P.J. Werter, W. Kus, I. Dobre, P. Marechal, T. Nair, H. Nielsen, J. Waites, J. B. Moraes Junior, T. Römer, J. Senior, P. Ionescu, S. Kalashetti, R. N. Ortega, Gail E. Hafley, G. A. Dan, Apur R. Kamdar, Ruth Ann Greenfield, David F. Kong, J. Bergallo, O. Barnum, Antonis S. Manolis, Sumeet Subherwal, S. Schaefer, A. Figueredo, Habib Gamra, S. Bandyopadhyay, V. Miloradovic, Imran Arif, Peter R. Carroll, M. Demirtas, S. Guidera, G. Rogelio, Naseem Jaffrani, N. Mulvihill, Marvin J. Slepian, Darren K. McGuire, Rohit Kalra, Luís A. Providência, F. Van de Werf, Andras Vertes, J. Xu, C. F. Gamio, R. G. Xuereb, R. F. Ramos, E. Kis, N. Bustros, M. De Luca, S. Zhurba, T. Connelly, S. Singhi, F. Gredler, Serdar Kucukoglu, Francesco Fedele, C. Chavez, Christoph Kadel, Antônio Carlos Sobral Sousa, S. Srimahachota, Igor Kaidashev, J. H. Garcia, I. Teodorescu, Birute Petrauskiene, O. Kracoff, Liwa T. Younis, Alain Bouchard, P. Osmancik, Y. Sun, C. Hammett, S. Sabri, William Wallace, Mehmet Yazici, L. Ermoshkina, Harish Chandna, G. Ramos-Lopez, M. Bronisz, Sergio Luiz Zimmermann, Giuseppe Ambrosio, V. Hergeldjieva, César A. Jardim, A. Rifai, H. Lui, A. Lee, J. Scholz Issa, A. Blenkhorn, P. Micale, V. Barbarich, C. Maccallum, Peter J. Grant, G. Topacio, N. Budassi, J. Yan, Keith A.A. Fox, Y. Xia, Jan H. Cornel, A. Rafael, Paul Hermany, S. Potthoff, Mohsin A.F. Khan, Pierre Coste, Neal Ready, N. T. Duda, M. Reyes, A. Chandran, I. G. Gordeev, Anne W. Beaven, B. J.B. Hamer, C. Treasure, Pravin Manga, M. R. Babarskiene, T. Devedzhiev, Alberto Menozzi, L. Lenarz, N. Llerena, Thomas F. Lüscher, Giovânio Vieira da Silva, Y. Malynovsky, L. Ramanathan, M. Belicova, M. O. Ibarra, D. Chew, R. Castillo, M. Kesselbrenner, A. H. Li, E. Baldjiev, M. El-Harari, S. H. Hur, S. Chiaramida, C. E. Chiang, Viliam Fridrich, L. R. Cartasegna, A. Yagensky, Steven E. Hearne, Gregory Pavlides, Witold Rużyłło, Y. Chandrashekhar, S. Welka, H. Petijean, Jose L. Leiva-Pons, Shaul Atar, Andrzej Lubiński, S. Zhao, János Tomcsányi, Narinder Singh, D. Banker, T. Boyek, H. Ebinc, N. Calambur, A. Mouhaffel, M. Creteanu, H. Huang, J. O. Jeong, E. Goudreau, D. Alexopoulos, E. Duronto, S. Car, O. Bashkirtsev, J. Mandak, V. Papademetriou, David O. Williams, Oscar Pereira Dutra, R. Baman, T. J. Hong, J. O. Ibañez, D. L. Gomez, R. K. Jain, R. Jozwa, L. Di Lorenzo, Matthew Wilson, Christian W. Hamm, A. Buakhamsri, Nikitas Moschos, Ashok Kumar, A. Kadiiski, C. Y. Lee, M. Opazo, J. Tang, E. Ferrari, P. Colon-Hernandez, Jean-Pierre Déry, B. Goloborodko, L. Gimple, Diego Ardissino, M. Bergovec, S. Thew, Dariusz Dudek, K. Tang, P. A.G. Zwart, A. Deshpande, S. Sathe, Yves Cottin, V. Pai, O. Koval, J. Lesnik, Pavan S. Reddy, A. Espinoza, Rungroj Krittayaphong, Carisi Anne Polanczyk, E. Kukuy, L. Tejada, J. Nobel, Renato D. Lopes, J. Bagatin, A. Manolova, E. Boudriot, A. Godoy, N. Perepech, Christopher D. Olympios, A. E. Guimarães, James Harris, Aref Rahman, D. Foley, H. J. Kruik, J. Bruguera I Cortada, I. Fotiadis, A. Bharani, Petar Otasevic, Eileen Brown, N. Gratsiansky, J. E. Poulard, Vladimir Gašparović, Habib Haouala, A. de Belder, J. Schmedtje, Lilia Nigro Maia, J. Cobos, Werner Benzer, E. Korban, A. U. Quraishi, X. Hong, A. Bazzi, P. Kotha, L. Gubolino, H. Ingersoll, Debra Marshall, Udo Sechtem, Sandipan Dutta, G. Frago, Anthony Mathur, Shaun G. Goodman, William Bachinsky, A. Hamer, Jaime Gomez, Patrizio Lancellotti, Vance Wilson, L. White, P.P. Mohanan, Aleksandar Knezevic, Sorin J. Brener, Susanna R. Stevens, H. Luquez, S. K. Lee, P. E. Leaes, P. Benjarge, T. Tu, Z. Coufal, N. Koliopoulos, Mahmut Şahin, X. Huang, S. Boldueva, J. De Souza, N. Chidambaram, S. Zolyomi, K. G. Shyu, H. Montecinos, A. Piombo, Wladmir Faustino Saporito, R. L. Kulkarni, I. Szakal, G. Arminio, M. Elbaz, Samir Pancholy, Jang Ho Bae, Giuseppe Musumeci, S. B. Zouari, A. Chois, D. Wojciechowski, A. Bakbak, E. Bozkurt, Kenneth J. Winters, R. Raugaliene, D. Sarkar, J. M. Alegret, Hubertus Heuer, E. Bobescu, E. Roncallo, R. Carlsson, R. Craig McLendon, L K Newby, K. Zrazhevskiy, João Pedro Ferreira, A. Haidar, D. Tellez, Robert Olszewski, Shmuel Gottlieb, H. Jure, A. Garcia Escudero, S. Sengupta, V. Ochean, W. Kostuk, G. Range, F. Leroy, G. Parale, R. Fernandez, M. Fulwani, M. Padovan, Y. Dovgalevskiy, Kreton Mavromatis, H. Hart, Y. G. Ko, F. Seixo, V. Bisne, J. McGarvey, Kimberly L. Blackwell, John H. Strickler, Sanjay Kumar, A. Bordonava, L. Egorova, C. Patocchi, A. Karczmarczyk, Chiara Melloni, Piyamitr Sritara, M. Anastasiou-Nana, Roman Szełemej, K. Penchev, D. Morales, M. Tokmakova, Krzysztof Zmudka, Rakesh Yadav, E. Bressollette, D. Nul, A. L. Astesiano, M. Urban, Abdulhay Albirini, C. T. Chin, F. Moulin, I. M. Coman, R. Watkin, J. Abanilla, J. Brønnum-Schou, J. Anusauskiene, P. Andrade Lotufo, Joseph G. Rogers, M. Bessen, P. C. Sartori, Paulo Roberto Ferreira Rossi, K. Atassi, H. V. Anderson, B. Klugherz, Bateshwar Prasad Singh, Mirza S. Baig, Z. Yusof, J. H. Geertman, A. Labroo, P. Nash, Freek W.A. Verheugt, Nancy J. Brown, M. A. Alcocer, A. Neskovic, L. Francek, Judith S. Hochman, A. Hoffmann, R. Dran, A. Podczeck-Schweighofer, Jeffry Katz, Josh Roberts, Roger E. McLendon, Ronald Rodriguez, T. Downes, A. Roth, L. E. Mayorga, Armagan Altun, José-Luis López-Sendón, M. Krotin, N. van der Merwe, O. Gigliotti, C. Park, G. Brigden, M. Kumbla, D. C G Basart, D. Erdogan, R. van Kranen, J. Beloscar, Johny Joseph, Pierluigi Tricoci, J. Marino, N. Mahon, S. Dani, I. Kovalskyy, Ioannis Nanas, V. Volkov, M. I. Edmilao, J. Kruells-Muench, F. Alamgir, R. Rinaldi, W. E. Mogrovejo, J. Mirat, C. Staniloae, S. Borromeo, H. Kozman, H. Zhang, Y. Zhou, S. Shurmur, A. Manari, M. A. Barrera, A. Vasylenko, D. Keedy, Paul A. Gurbel, Ali Oto, Charles R. Lambert, V. G. Ribeiro, A. Quintero, H. Joshi, L. Tang, J. Allan, C. S. Díaz, F. Carvalho Neuenschwander, Mircea Cintezǎ, M. Kokles, G. Piovaccari, Z. Kovacs, W. Li, C. Beauloye, E. J. Ramos, D. Bertolim Precoma, J. Burstein, G. Covelli, E. C. Zambrano, Assen Goudev, A. Tang, F. Henriquez, S. Tangsuntornwiwat, C. Kirma, GR Aycock, Kenneth W. Mahaffey, M. Ardnt, Jose C. Nicolau, O. Barbarash, E. K. Shin, P. Potapenko, T. Supryadkina, Asok Venkataraman, W. Mogrovejo, M. Acikel, R. Bohorquez, M. Syvänne, M. Chan, H. Mardikar, H. Berlin, O. Quintana, K. Heintz, J. M. Bastos, Guillermo Llamas Esperon, G. Aroney, J. Chen, Nancy H. Collins, C. Ahsan, G. Heins, F. Baer, V. Kondle, Nicholas Danchin, G. Shetty, Sergio Berti, Philip E. Aylward, James Cotton, G. S. Vallejo, Massimo Volpe, Z. Vasiljevic-Pokrajcic, C. Bugueño, Seung Woon Rha, S. Ilic, G. E. Stanciulescu, Z. Li, D. Nassiacos, R. Sciberras, S. Kuanprasert, Denilson Campos de Albuquerque, M. Pavlovic, Craig S. Barr, Mohammed R. Essop, John G. Canto, David T. Roberts, M. Ozdemir, Jacquelyn Miller, T. K. Ong, Sian E. Harding, V. Bose, J. Yoon, R. Syan, M. A. Paz, O. Maskon, Dennis V. Cokkinos, L. Kraus, Z. Masud, K. Amosova, M. Boyarkin, L. Mos, Dmitry Zamoryakhin, Arif Anis Khan, Jeffrey A. Breall, A. Gallino, Ivo Petrov, F. A. Alves da Cost, Saul Vizel, Hugo Vargas Filho, P. Kaewsuwanna, G. Antonelli, Chuen Den Tseng, I. Vakaliuk, J. Miklin, A. El Hawary, Ashok Jacob, D. Gumm, Kurt Huber, G. Pajes, N. Jathappa, Stanislaw Bartus, P. V. Lavhe, C. Romero, J. Balkin, T. Gould, R. Durgaprasad, Felipe Martinez, Henning Ebelt, A. Puri, D. K. Agarwal, E. E. Buyukoner, R. Mora Junior, P. Poliacik, A. Dande, X. Zhao, J. Floro, A. Bagriy, Yuliya Lokhnygina, M. Atieh, V. Batushkin, Valentin Markov, O. Karpenko, Peter Clemmensen, P. Castro, L. Paloscia, F. Florenzano, J. L. Accini, Tony Schibler, J. Arneja, W. Wu, B. Andruszkiewicz, Michael A. Morse, P. Vojtisek, D. Sadler, S. Frischwasser, M. Cayli, W N Leimbach, E. Flores, B. Wang, A Sosa Liprandi, Y. Michalaros, H. C. Finimundi, Raul D. Santos, N. Vijay, E. Magnus Ohman, Y. Karpenko, J. Sirotiakova, Z. Shogenov, D A Zateyshchikov, Eric P. Viergever, R. Bach, Gary S. Niess, D. C. Acosta, G. Piegari, J. B. Gupta, J. Shanes, E. Ronner, J. Arter, Claudio Cavallini, M. A. Hominal, V. Bugan, S. D. Varini, K. Nyman, B. G. Castillo, Sinan Aydoğdu, N. Novikova, D. Wang, P. Simpson, Y. Huang, Taral Patel, Gabriel Tatu-Chitoiu, D. Silva Junior, H. Theron, C. Alvarez, Anikó Ilona Nagy, T. Chua, P. Georgiev, D. Rittoo, G. De Luca, R. Blonder, Alberto Caccavo, D. Koganti, E. Manenti, N. Ghaisas, G. Letcher, D. Platogiannis, Arshed A. Quyyumi, J. Dy, Z. Ples, W. Kunz Sebba Barroso de Souza, Hamid Taheri, S. Kammoun, A. Salvioni, B. Stockins, K. Sutalo, J. C. Post, Merih Kutlu, Vijay K. Chopra, C. Mathis, Stephen M. Schwartz, Manish Jain, D. Coisne, A. Goudev, A. Dalby, João Morais, P. van Kalmthout, Andrzej Budaj, I. Dotani, L. Mircoli, R. Vicari, J. P. Herrman, M. Moran, G. Lupkovics, Alexander Parkhomenko, J. Heath, Andrew Moriarty, C. Pop, J. Y. Hwang, S. Kassam, R. Martingano, I. Nikolskaya, Z. Zheng, Johann S. de Bono, M. Izzo, R. Labonte, E. H. Forte, W. Moleerergpoom, Piera Angelica Merlini, D. Lee, W. Macias, G. Syan, S. Zhou, S. W. Kim, T. Duris, E. Shaoulian, Andreas U. Wali, Marco Antonio Mota Gomes, Pritibha Singh, M. Ovize, M. Del Core, W. Bowden, B. Xu, Ravi Bhagwat, C. Wongvipaporn, J. Vojacek, Steven Lindsay, F. McGrew, J. Gorny, J. D. Pappas, R. Vuyyuru, J. Chahin, Ashraf Reda, T. Lau, E. Conn, J. Meisner, S. Meymandi, A. D. Hrabar, M. Slanina, D. Jarasuniene, C. Lang, A. Vo, Christian Hamm, H. Gogia, Z. Yuan, T. Mathew, A. Van Dorpe, J. Kettner, M. Barbiero, Harvey D. White, L. Rudenko, V. Jain, M. Carter, David Erlinge, G. Ma, V. Sierkova, D. K. Kim, Steven O. Smith, R. K. Premchand, P. Jetty, J. Y. Hou, V. Simanenkov, T. Kaelsch, David P. Foley, A. Francis, Piotr Ponikowski, Ramón Corbalán, D. Connolly, J. Tuma, R. Zambahari, Miodrag Ostojic, R. Lamich, A. Rabelo Alves, V. Tseluyko, G. Moises Azize, L. Khaisheva, G. Pencheva, C. Ingram, J. Cooke, A. Prado, M. De Tollenaere, M. Kim, Alan Rees, Melanie B. Turner, Mark B. Abelson, H. L. Luciardi, L. Illyes, R. Sarma, L. Manriquez, J. A. Marin Neto, D. Iordachescu-Petica, G. Hoedemaker, Victor S. Gurevich, F. Ridocci, J. Grman, F. Waxman, Jorge F. Saucedo, E. Boughzala, B. S. Jagadesa, Heba Abdullah, A. Weiss, N. Bichan, L. Tami, Y. Bouzid, N. I. Gomez, Zafar Sy, Béla Merkely, J. P. Albisu, L. Rodriguez-Ospina, John C. Chambers, L. L. Lobo Marquez, R. Guan, Steven Georgeson, M. K. Sarna, L. Nogueira Liberato de Sousa, Mika Laine, P. Pimentel Filho, Teresa Kawka-Urbanek, G P Arutyunov, S. Elhadad, A. Dambrauskaite, R. Leon de la Fuente, Audes D. M. Feitosa, P. Baetslé, Abraham Al Ahmad, José Francisco Kerr Saraiva, Roland P.T. Troquay, J. Berlingieri, Margaret Arstall, J. L. Coronado, K. Yang, S. V. Shalaev, Bernard J. Gersh, A. El-Etreby, Elżbieta Zinka, F. De Valais, John E.A. Blair, P. Fajardo, M. Rodriguez, R. Boujnah, H. Hammerman, Y. S. Chong, Stigi Joseph, M. H. Jeong, J. Ge, Q. He, Robert S Iwaoka, Bimal R. Shah, J. Sawhney, T. Sakulsaengprapha, G. Werner, Jill Anderson, M. Hondl, Meinrad Gawaz, Gilmar Reis, M. Dalkowski, Tomáš Janota, M. Damiao Gomes Seabra, A. Dharmadhikari, Aleš Linhart, John Elliott, Kodangudi B. Ramanathan, Doron Zahger, Dilek Ural, L. Regos, F. R. Bolohan, Marcello Galvani, B. Zakhary, N. Qureshi, D. Deac, Maria Emília Figueiredo Teixeira, T. Venter, Santosh Gupta, W. Wright, P. Telekes, A. Furber, V. Nykonov, Zhu Junren, M. Cinteza, I. Lang, S. Junejo, D. Martins, Mauro Esteves Hernandes, G. Ishmurzin, Anthony J. Dalby, R. Scioli, P. Babu, R. Habaluyas, V. Mendoza, G. B. Scaro, Matthew T. Roe, M. Senaratne, D. J. van der Heijden, T. Pillay, Yoav Turgeman, J. Moreira, C. Cuccia, C. Astarita, S. De Servi, Robert G. Wilcox, M. C. Constantinescu, Kardiyoloji, Roe Matthew, T., Armstrong Paul, W., Fox Keith, A. A., White Harvey, D., Prabhakaran, Dorairaj, Goodman Shaun, G., Cornel Jan, H., Bhatt Deepak, L., Clemmensen, Peter, Martinez, Felipe, Ardissino, Diego, Nicolau Jose, C., Boden William, E., Gurbel Paul, A., Ruzyllo, Witold, Dalby Anthony, J., McGuire Darren, K., Leiva Pons Jose, L., Parkhomenko, Alexander, Gottlieb, Shmuel, Topacio Gracita, O., Hamm, Christian, Pavlides, Gregory, Goudev Assen, R., Oto, Ali, Tseng Chuen, Den, Merkely, Bela, Gasparovic, Vladimir, Corbalan, Ramon, Cinteza, Mircea, McLendon R., Craig, Winters Kenneth, J., Brown Eileen, B., Lokhnygina, Yuliya, Aylward Philip, E., Huber, Kurt, Hochman Judith, S., Ohman E., Magnu, and Golino, Paolo

Subjects
Male, Prasugrel, Myocardial Infarction, Kaplan-Meier Estimate, Piperazines, Purinergic P2 Receptor Antagonists, Myocardial infarction, education.field_of_study, Cardiovascular diseases [NCEBP 14], Acute Coronary Syndrome, Aged, Angina, Unstable, Aspirin, Cardiovascular Diseases, Double-Blind Method, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Middle Aged, Platelet Aggregation Inhibitors, Prasugrel Hydrochloride, Stroke, Thiophenes, Ticlopidine, Medicine (all), Hazard ratio, Clopidogrel, Acute Coronary Syndromes, General Medicine, Angina, Combination, Cardiology, medicine.drug, medicine.medical_specialty, Acute coronary syndrome, Population, Unstable, Drug Therapy, General & Internal Medicine, Internal medicine, medicine, cardiovascular diseases, education, Acute coronary syndromes, Revascularisation, Unstable angina, business.industry, medicine.disease, REVASCULARIZAÇÃO MIOCÁRDICA, business
Abstract

Item does not contain fulltext BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P=0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P=0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. CONCLUSIONS: Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

Published
2012
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6. Effect of Glucose-Insulin-Potassium Infusion on Mortality in Patients With Acute ST-Segment Elevation Myocardial Infarction

Author

H. Ge, A. Gentile, H. Yang, X. Guo, H. Bai, R. B. Panwar, R. Crivello, V. E. Shegokar, Supriya Patil, X. Sun, M. Y. Bai, Sonia Gupta, S. Shanmugasundaram, D. X. Li, S. Dwivedi, J. P. Albisu, N. Dinesh, R. Liu, Rajvir Singh, S. M. Macin, J. Tang, H. Tan, K. Wang, S. Jia, L. L. Lobo Marquez, C. Baigent, K. Varghese, S. T. Zhang, Prafulla Kerkar, A. V. Bindu, R. Umrani, P. Yang, S. Sanghvi, F. Wang, Z. X. Liu, S. Tredici, Y. Cao, I. Tsuluca, Ratnakar, W. G. Li, N. Chidambaram, P. J. Nathani, Ravi Mehrotra, D. Qiao, A. S. Jain, S. S. Fatima, P. Baselga, D. Wojdyla, Sudhir Naik, J. B. Bijapure, J. Fu, Q. Zhang, Z. Ma, X. Xu, J. Srinivas, Jun Zhu, O. Pellizon, J. Martinez Sanchez, P. Castro, R. E. Ledesma, U. Legler, Q. Cui, Janice Pogue, M. Chenniappan, N. F. Zho, Atanu Biswas, C. M. Yang, M. Garrido, D. Duggal, Shamir R. Mehta, E. Hernandez Leyva, C. E. Girino, N. Wang, Z. Fang, R. Udaysankar, S. C. Manchanda, G. Wang, X. Zhao, R. Monti, H. R. Devendrappa, Harvey D. White, J. Rajesh, J. Wei, N. Wu, R. K. Tongia, L. R. Cartasegna, E. M. Good God, S. Fan, C. Zai, E. Carrillo, S. N. Ferreyra Cantante, R. J. Ahmed, J. Prajapati, X. Hao, M. Fulwani, S. K. Rane, B. S.V. Raj, D. Freeda, J. Bono, A. J. Gambarte, G. Reis, S. Dong, Amal Kumar Khan, Z. R. Tian, M. S. Rao, Denis Xavier, Rinku Sharma, Y. Q. Jiang, B. K.S. Sastry, Y. Wang, V. S. Reddy, X. Yin, G. S.R. Murthy, W. Li, M. G. Yang, DC Rao, M. J. Santhosh, F. Huo, A. K. Maity, T. Wang, J. A. Sanchez, Prem Pais, J L Ramos, S. R. Mehta, S. Y. Lang, P. Gandhimadhinathan, K. K. Haridas, Sanjoy K. Paul, J. Shao, L. H. Wang, S. Mehrotra, S. Wang, B. Isaac, Pradeep Kumar, Luiz Carlos Bodanese, S. Zhang, X. Zhang, Job E. Lopez, C. Becerra, S. S. Iyengar, V. K. Puri, L. S. Zhou, F. Guan, R. Kishore, A. Nambiar, Kadir González, S. Y. Fu, S. Pavlov, R. Pitarch Flors, B. M. Lombana, X. Jiang, G. F. Xie, B. S. Raju, E. Assanelli, P. Nyayadhish, Abdul Hameed, Shriprakash Kalantri, U. Magin, V. S.P. Rao, D. F. Li, C. Y. Liu, E. B. Manoj, Z. Wang, L. Liu, D. M. Mello Soares, K. Soomro, H. Zhang, G. J. Yang, A. Puri, R. Zhqo, A. A. Fernandez, S. Raghavan, J. C. Zhou, W. Zhang, I. Chandna, T. Yang, S. C. Xu, J. Li, M. Zhao, J. Zhang, L. Hao, R. F. Ramos, R. Rajaram, S. Shang, Y. Yang, G. Verma, G. Tao, Y. Miao, P. Castro Galvez, H. Ma, R. Ma, N. L. Sun, E. M. Avila, A. Kalla, S. Ren, C. R. Castellanos, J. Boben, X. You, R. Beniwal, Z. Nan, R. J. Barcudi, Changchun Xie, S. Lidwin, P. R. Nayak, S. S. Ramesh, Cláudia B.R. Martinez, Z. D. Wu, A. Caccavo, Javed Tai, Y. Han, Y. S. Wu, D. Hu, Sharad Chandra, P. B. Latha, Y. Tu, S. Chen, A. Garg, D. Q. An, K. J. Nesaraj, M. Alcaino, X. C. Xu, S. P. Ma, L. Cronin, J. J. Cui, L. Marsano, P. Sleight, H. Saad, H. Liu, Alvaro Avezum, F. Torres, O. P. Soni, G. K. Aneja, Rafael Diaz, R. Guo, H. ul Banna, B. Srinivasulu, Q. F. Zhang, S. Yusuf, J. Zhu, H. S. Yang, W. Wang, P. Ramesh, D. Agnelli, J. Liu, X. Y. Shi, Salim Yusuf, S. K. Trivedi, S. G. Yang, Darren K. McGuire, W. K. Li, H. L. Luciardi, Q. Li, G. Huang, F. Van de Werf, J. Huang, S. B. Siwach, I. Rasool, Q. Zheng, X. Chi, Álvaro Pascual, E. Marzetti, Antonio Carlos Carvalho, Y. Zhang, M. A. Alvarez, S. D. Zawar, Johny Joseph, Y. C. Song, C. B. Xu, C. He, Bateshwar Prasad Singh, R. J. Freedman, Ramón Corbalán, C. Cheng, R. Trehan, S. L. Tungikar, P. Pais, P. K. Shetty, Z. R. Lu, Pradeep Joshi, M. Molec, L. Prestes, C. A. Cuneo, Ernesto Paolasso, Y. Q. Li, S. Rehman, J. Ma, Wael Almahmeed, M. A. Berli, L. Soares Piegas, D. Almeida, Z. M. Xu, G. Sidhu, R. A. Ahuad Guerrero, Z. Fan, U. K. Mahorkar, X. Tan, J. E. Isea Perez, T. Pradeep, S. M. Li, S. Zhou, P. J.C. Lujan, M. A. Hominal, A. D. Orlandini, R. Wang, S. A. Khan, N. Transk, Dorairaj Prabhakaran, Z. Hou, J. Pogue, Y. H. Liu, R. A. Peleteiro Mariño, K. N. Pradeep, John N. Nanas, A. Hamer, V. Mezzina, M. I. Genisans, P. Srinivas, E. Manenti, H. Singh, S. Adil, E. Ferro Queirel, N. Bender, D. Li, J. Cheng, Susmita Kaushik, J. Lou, R. K. Jain, J. Hiremath, V.K. Katyal, F. Zhao, Y. Jiang, Y. G. Zhang, N. Dadani, S. Thanikachalam, Khawar Kazmi, G. Yang, X. Tian, D. Barkavi, Ashok Kumar, X. Ma, W. J. Zhang, C. Shen, Q. L. Li, F. Li, W. Chen, A. Alves De Lima, B. Wang, D. Tian, T. N.C. Padmanabhan, M. B. Rao, A. Kalanidhi, K. Bhojomal, Lisheng Liu, G. D. Caime, N. G. Mohanarjun, B. R. Babu, F. Zhangfang, P. Bacher, L. Marano, S. Y. Liu, H. Xu, K. Ahmed, J. Narendra, Y. Xia, T. M. Jaison, G. Tognoni, X. Li, B. Yang, R. Calton, S. Sinha, A. R. Gonzalez Medina, S. Y. Yu, E. Paolasso, G. Qi, J. Muntaner, C. Z. Zhang, K. Jing, M. Ramesh, N. Cano Lopez, Rajnish Joshi, S. L. Liu, S. Balasubramaniyan, R. J. Balado, G. Deepak, Q. P. Wang, J. G. De Castro Amino, J. K. Chhaparwal, Q. Wang, X. Yang, L. Gong, Z. Zhang, Y. Kumble, A. Bharani, A. S.V.N. Rao, R. Corbalán Herreros, B. J. Kumar, G. Jacob, Y. Sun, S. Fu, Z. Xu, Z. C. Li, S. W. Wang, U. Raschke, D. Xavier, M. A. Brito, W. Liu, L. Li, G. Amuchastegui, S. Verma, W. Taylor, M. Rafiq, Jagdish, Mohammad Zubaid, J. Zhou, Sanjay Kalra, L. Yan, J. Carrillo Calvillo, I. Holadyk-Gris, S. R. Naik, Andrés Orlandini, T. X. Cui, H. Ozcoidi, Shweta Sharma, T. Chen, G. Covelli, Seemala Saikrishna Reddy, Y. Qin, D. H. Yan, G. Zapata, J. Lopez Ferre, A. Bozzano, R. Wadhwani, S. T. Chandy, J. Zhao, Rakesh Gupta, M. Gao, G. Xu, B. R. Malipeddi, A. Somani, A. Abdulminem, G. M. Font, K. Jeremaiah, K. G. Alexander, Jinhai Yang, C. Mata, H. R. Ramos, V. Vijan, Z. Zhen, Prashant P. Joshi, H. U. Banna, Z. C. Liu, O. A. Perrino, X. J. Bai, F. S. Zhou, J. O. Balbi, P. Papazoglou, H. Li, S. Dani, Z. Li, A. Nejrotti, H. G. Yang, R. Uchoa Azevedo, J. F. Shallam, Jack Hirsh, John Kanakakis, Rashid J. Ahmed, A. M. Faruqi, K. D. Rao, P. A. Jiwani, S. Borade, M. San Mauro, H. Chen, R. G. Salkar, X. Wang, P.P. Mohanan, A. Li, Anubhav Mittal, K. Zai, P. Guo, Carmen de la Cuesta, R. Nordaby, and Q. Meng

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Cardiogenic shock, Percutaneous coronary intervention, Context (language use), General Medicine, Thrombolysis, medicine.disease, law.invention, Reperfusion therapy, Randomized controlled trial, law, Heart failure, Internal medicine, medicine, Cardiology, Myocardial infarction, Medical emergency, business
Abstract

Context Glucose-insulin-potassium (GIK) infusion is a widely applicable, low-cost therapy that has been postulated to improve mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). Given the potential global importance of GIK infusion, a large, adequately powered randomized trial is required to determine the effect of GIK on mortality in patients with STEMI. Objective To determine the effect of high-dose GIK infusion on mortality in patients with STEMI. Design, setting, and participants Randomized controlled trial conducted in 470 centers worldwide among 20,201 patients with STEMI who presented within 12 hours of symptom onset. The mean age of patients was 58.6 years, and evidence-based therapies were commonly used. Intervention Patients were randomly assigned to receive GIK intravenous infusion for 24 hours plus usual care (n = 10,091) or to receive usual care alone (controls; n = 10,110). Main outcome measures Mortality, cardiac arrest, cardiogenic shock, and reinfarction at 30 days after randomization. Results At 30 days, 976 control patients (9.7%) and 1004 GIK infusion patients (10.0%) died (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.95-1.13; P = .45). There were no significant differences in the rates of cardiac arrest (1.5% [151/10 107] in control and 1.4% [139/10,088] in GIK infusion; HR, 0.93; 95% CI, 0.74-1.17; P = .51), cardiogenic shock (6.3% [640/10 107] vs 6.6% [667/10 088]; HR, 1.05; 95% CI, 0.94-1.17; P = .38), or reinfarction (2.4% [246/10,107] vs 2.3% [236/10,088]; HR, 0.98; 95% CI, 0.82-1.17; P = .81). The rates of heart failure at 7 days after randomization were also similar between the groups (16.9% [1711/10,107] vs 17.1% [1721/10,088]; HR, 1.01; 95% CI, 0.95-1.08; P = .72). The lack of benefit of GIK infusion on mortality was consistent in prespecified subgroups, including in those with and without diabetes, in those presenting with and without heart failure, in those presenting early and later after symptom onset, and in those receiving and not receiving reperfusion therapy (thrombolysis or primary percutaneous coronary intervention). Conclusion In this large, international randomized trial, high-dose GIK infusion had a neutral effect on mortality, cardiac arrest, and cardiogenic shock in patients with acute STEMI.

Published
2005
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