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| 1 | 非ST段抬高型急性冠状动脉综合征患者中的肥胖矛盾现象:来自CRUSADE(对不稳定型心绞痛患者进行快速风险分层能否减少早期实施ACC/AHA指南的不良预后)质量改进研究的结果显示文摘Background: Although obesity is a known risk factor for coronary artery disease, its impact on the presentation, treatment, and outcome of patients with acute coronary syndromes(ACS) has not been well studied. Methods: Using data from the CRUSADE Initiative, we compared inhospital treatments and clinical outcomes of 80 845 patients with high-risk non-ST-segment elevation(NSTE) ACS(positive cardiac markers and/or ischemic ST-segment changes) to determine whether there was an association with body mass index(BMI[kg/m2]). Patient weights were categorized according to World Health Organization classifications: Underweight(BMI< 18.5), Normal range(BMI 18.5-24.9), Overweight(BMI 25-29.9), Obese Class I(BMI 30-34.9), Obese Class Ⅱ(BMI 35-39.9), and Extremely Obese(BMI≥40). Results: Most(70.5%) of the CRUSADE patients were classified as overweight or obese; these patients were younger and more likely to present with comorbid conditions, including diabetes mellitus, hypertension, and hyperlipidemia. Medications given during the first 24 hours and invasive cardiac procedures recommended by the American College of Cardiology/American Heart Association guidelines for NSTE ACS were more commonly used in these patients. The incidence of death and death and reinfarction, adjusted for covariates, were generally lower in overweight and obese patients, compared with normal-weight patients, but higher in underweight and extremely obese patients. Conclusions: Most patients with NSTE ACS are overweight or obese. These patients receive more aggressive treatment, and, except for the extremely obese, have less adverse outcomes compared with underweight and normal-weight patients. Although obesity appears to be a risk factor for developing ACS at a younger age, it also appears to be associated with more aggressive ACS management and, ultimately, improved outcomes. | Diercks D.B. Roe M.T. Mulgund J. 罗亮 | 2006 | 世界核心医学期刊文摘(心脏病学分册)2006，，12： | 2 |
| 2 | 拟行冠状动脉搭桥术的非ST段抬高型急性冠状动脉综合征患者中急性使用氯吡格雷与预后的关系显示文摘Objectives: We sought to characterize patterns of clopidogrel use before coronary artery bypass grafting(CABG) and examine the drug’s impact on risks for postoperative transfusions among patients with non-ST-segment elevation acute coronary syndromes(NSTE ACS). Background: Adherence in community practice to American College of Cardiology/American Heart Association guidelines for clopidogrel use among NSTE ACS patients has not been previously characterized. Methods: We evaluated 2,858 NSTE ACS patients undergoing CABG at 264 hospitals participating in the CRUSADE(Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Initiative. We examined the patterns of acute clopidogrel therapy and its association with bleeding risks among those having “early”CABG ≤5 days and again among those having “late”surgery >5 days after catheterization. Results: Within 24 h of admission, 852 patients(30%) received clopidogrel. In contrast to national guidelines, 87%of clopidogrel-treated patients underwent CABG ≤5 days after treatment. Among those receiving CABG within ≤5 days of last treatment, the use of clopidogrel was associated with a significant increase in blood transfusions(65.0%vs. 56.9%, adjusted odds ratio[OR] 1.36, 95%confidence interval[CI] 1.10 to 1.68) as well as the need for transfusion of ≥4 U of blood(27.7%vs. 18.4%, OR 1.70, 95%CI 1.32 to 2.19). In contrast, acute clopidogrel therapy was not associated with higher bleeding risks if CABG was delayed >5 days(adjusted OR 1.18, 95%CI 0.54 to 2.58). Conclusions: Despite guideline recommendations, the overwhelming majority of NSTE ACS patients treated with acute clopidogrel needing CABG have their surgery within ≤5 days of treatment. A failure to delay surgery is associated with increased blood transfusion requirements that must be weighed against the potential clinical and economic impacts of such delays. | Mehta R.H. Roe M.T. Mulgund J. 黄浙勇 | 2006 | 世界核心医学期刊文摘(心脏病学分册)2006，，12： | 1 |
| 3 | 口服乙酰半胱氨酸不能稳定已确立的重度先兆子痫进程显示文摘Objective: To stabilise the disease process in women with early onset severe preeclampsia and/or HELLP syndrome by enhancing maternal antioxidants effects of glutathione. Study design: In a randomised, double-blind, placebo-controlled trial, women with severe preeclampsia and/or HELLP syndrome received oral N-acetylcysteine. Primary outcome measures were disease stabilisation expressed as treatment-to-delivery interval and biochemical assessment of glutathione and parameters of oxidative stress. Secondary outcome measures were maternal complications, rate of caesarean section, stay at intensive care unit, postpartum hospital stay and neonatal morbidity and mortality. Analyses were done by intention-to-treat using Wilcoxon’s two-sample test and regression analysis. Results: Median treatment-to-delivery interval was not significantly different between the N-acetylcysteine and placebo group. The whole blood and plasma levels of glutathione and other thiols were not affected by N-acetylcysteine administration, except for plasma homocysteine concentrations, which were lower in the N-acetylcysteine group. There were no differences found in maternal nor neonatal secondary outcome measures between both groups. Con-clusion: Oral N-acetylcysteine administration does not stabilise the disease process of early onset severe preeclampsia and/or HELLP syndrome. | Roes E.M. Raijmakers M.T. Boo T.M.d. 朱晓明 | 2006 | 世界核心医学期刊文摘(妇产科学分册)2006，0，10： | 0 |
| 4 | 非ST段抬高型急性冠状动脉综合征治疗中的抗血小板和抗凝药物过量显示文摘Context: Effective medical care assumes delivery of evidence-based medicines to appropriate patients with doses comparable to those studied. Objective: To investigate dosing of unfractionated heparin(UFH), low-molecular- weight heparin(LMWH), and glycoprotein IIb/IIIa inhibitors, and the association between dosing and major outcomes. Design, Setting, and Participants: A prospective observational analysis in 387 US academic and nonacademic hospitals of 30 136 patients from the CRUSADE(Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/ American Heart Association Guidelines) National Quality Improvement Initiative Registry who had non-ST-segment elevation acute coronary syndromes(NSTE ACS) with chest pain and either positive electrocardiograms or cardiac biomarkers between January 1 and September 30, 2004. Main Outcome Measures: Excessive dosing of UFH, LMWH, and glycoprotein IIb/IIIa inhibitors and major clinical outcomes, including bleeding, in-hospital mortality, and length of stay. Results: A total of 3354 patients(42% ) with NSTE ACS who were administered antithrombotic agents received at least 1 initial dose outside the recommended range. An excess dose was administered to 2934 patients(32.8% ) treated with UFH, 1378(13.8% ) treated with LMWH, and 2784(26.8% ) treated with glycoprotein IIb/IIIa inhibitors. Factors associated with excess dosing included older age, as well as female sex, renal insufficiency, low body weight, diabetes mellitus, and congestive heart failure. Relative to those patients not administered excess dosages, patients with excess dosages of UFH, LMWH, and glycoprotein IIb/IIIa inhibitors either tended toward or had higher risks for major bleeding(adjusted odds ratio[OR], 1.08; 95% confidence interval[CI], 0.94- 1.26; OR, 1.39; 95% CI, 1.11- 1.74; and OR, 1.36; 95% CI, 1.10- 1.68; respectively). Bleeding increased relative to the degree of excess dose and to the number of agents administered in excess(6.6% [237/3590] if neither heparin nor glycoprotein IIb/IIIa excess vs 22.2% [93/419] if both excess). Mortality and length of stay were also higher among those patients administered excess dosing. We estimated that 15% (400/2766) of major bleeding in this population may be attributable to excess dosing. Conclusions: Patients with NSTE ACS treated in the community often receive excess doses of antithrombotic therapy. Dosing errors occur more often in vulnerable populations and predict an increased risk of major bleeding. | Alexander K.P Chen A.Y Roe M.T. 刘宇 | 2006 | 世界核心医学期刊文摘(心脏病学分册)2006，2，5： | 0 |
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