ABRUPT WITHDRAWAL OF BETA-BLOCKADE THERAPY IN PATIENTS WITH MYOCARDIAL-INFARCTION - EFFECTS ON INFARCT SIZE, LEFT-VENTRICULAR FUNCTION, AND HOSPITAL COURSE
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作者:
CROFT, CH
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
CROFT, CH
RUDE, RE
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
RUDE, RE
GUSTAFSON, N
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
GUSTAFSON, N
STONE, PH
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
STONE, PH
POOLE, WK
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
POOLE, WK
ROBERTS, R
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
ROBERTS, R
STRAUSS, HW
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
STRAUSS, HW
RAABE, DS
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
RAABE, DS
THOMAS, LJ
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
THOMAS, LJ
JAFFE, AS
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
JAFFE, AS
MULLER, J
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
MULLER, J
HOAGLAND, P
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HOAGLAND, P
SOBEL, BE
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SOBEL, BE
PASSAMANI, ER
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
PASSAMANI, ER
BRAUNWALD, E
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
BRAUNWALD, E
WILLERSON, JT
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机构:UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
WILLERSON, JT
机构:
[1] UNIV TEXAS, HLTH SCI CTR,DEPT INTERNAL MED,DIV CARDIOL, 5323 HARRY HINES BLVD, DALLAS, TX 75235 USA
[2] PARKLAND MEM HOSP, DALLAS, TX 75235 USA
[3] BARNES HOSP, MILIS CLIN UNITS, ST LOUIS, MO 63110 USA
[4] BRIGHAM & WOMENS HOSP, BOSTON, MA 02115 USA
[5] MASSACHUSETTS GEN HOSP, BOSTON, MA 02114 USA
[6] MED CTR HOSP VERMONT, BURLINGTON, VT 05401 USA
The effects of abrupt withdrawal or continuation of .beta.-blockade therapy during acute myocardial infarction were evaluated in 326 patients participating in the Multicenter Investigation of the Limitation of Infarct Size (MILIS). Thirty-nine patients previously receiving a .beta.-blocker and randomly selected for withdrawal of .beta.-blockers and plaebo treatment during infarction (group 1) were compared with 272 patients previously untreatred with .beta.-blockers who were also randomly assigned to placebo therapy (group 2). There were no significant differences between the two groups in MB creatine kinase isoenzyme (15.8 .+-. 10.9 vs 18.2 .+-. 14.4 g-eq/m2, respectively) estimates of infarct size, radionuclide-determined left ventricular ejection fractions within 18 hr of infarction (0.44 .+-. 0.15 vs. 0.47 .+-. 0.16) or 10 days later (0.42 .+-. 0.47 .+-. 0.16), creatine kinase-determined incidence of infarct extension (13% vs 65), congestive heart failure (43% vs 37%), nonfatal ventricular fibrillation (5% vs 7%), or in-hospital mortality (13% vs 9%). Patients in group 1 had more recurrent ischemic chest pain (p = .002) within the first 24 hr after infarction, but not thereafter. However, this did not appear to be related to a rebound increase in systolic blood pressure, heart rate, or double product. In a separate analysis, 20 propranolol-eligible group 1 patients randomly selected for withdrawal of .beta.-blockade (group 3) were compared with 15 patients randomly selected for continuation of prior .beta.-blockade therapy (group 4). This comparison yielded similar results. These data indicate that the .beta.-blockade withdrawal phenomenon is not a major clinical problem in patients with acute myocardial infarction. .beta.-Blockade therapy can be discontinued abruptly during acute myocardial infarction if clinically indicated.
机构:
WASHINGTON UNIV, SCH MED, CARDIOVASC DIV, 660 S EUCLID AVE, ST LOUIS, MO 63110 USAWASHINGTON UNIV, SCH MED, CARDIOVASC DIV, 660 S EUCLID AVE, ST LOUIS, MO 63110 USA
ROBERTS, R
HENRY, PD
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WASHINGTON UNIV, SCH MED, CARDIOVASC DIV, 660 S EUCLID AVE, ST LOUIS, MO 63110 USAWASHINGTON UNIV, SCH MED, CARDIOVASC DIV, 660 S EUCLID AVE, ST LOUIS, MO 63110 USA
HENRY, PD
SOBEL, BE
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机构:
WASHINGTON UNIV, SCH MED, CARDIOVASC DIV, 660 S EUCLID AVE, ST LOUIS, MO 63110 USAWASHINGTON UNIV, SCH MED, CARDIOVASC DIV, 660 S EUCLID AVE, ST LOUIS, MO 63110 USA
机构:
WASHINGTON UNIV, SCH MED, CARDIOVASC DIV, 660 S EUCLID AVE, ST LOUIS, MO 63110 USAWASHINGTON UNIV, SCH MED, CARDIOVASC DIV, 660 S EUCLID AVE, ST LOUIS, MO 63110 USA
ROBERTS, R
HENRY, PD
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机构:
WASHINGTON UNIV, SCH MED, CARDIOVASC DIV, 660 S EUCLID AVE, ST LOUIS, MO 63110 USAWASHINGTON UNIV, SCH MED, CARDIOVASC DIV, 660 S EUCLID AVE, ST LOUIS, MO 63110 USA
HENRY, PD
SOBEL, BE
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机构:
WASHINGTON UNIV, SCH MED, CARDIOVASC DIV, 660 S EUCLID AVE, ST LOUIS, MO 63110 USAWASHINGTON UNIV, SCH MED, CARDIOVASC DIV, 660 S EUCLID AVE, ST LOUIS, MO 63110 USA