Author
David J. Moliterno
Other affiliations: Case Western Reserve University, Durham University, Cleveland Clinic ...read more
Bio: David J. Moliterno is an academic researcher from University of Kentucky. The author has contributed to research in topics: Myocardial infarction & Percutaneous coronary intervention. The author has an hindex of 72, co-authored 328 publications receiving 20222 citations. Previous affiliations of David J. Moliterno include Case Western Reserve University & Durham University.
Papers published on a yearly basis
Papers
More filters
TL;DR: Blood transfusion in the setting of acute coronary syndromes is associated with higher mortality, and this relationship persists after adjustment for other predictive factors and timing of events.
Abstract: ContextIt is unclear if blood transfusion in anemic patients with acute coronary
syndromes is associated with improved survival.ObjectiveTo determine the association between blood transfusion and mortality
among patients with acute coronary syndromes who develop bleeding, anemia,
or both during their hospital course.Design, Setting, and PatientsWe analyzed 24 112 enrollees in 3 large international trials of
patients with acute coronary syndromes (the GUSTO IIb, PURSUIT, and PARAGON
B trials). Patients were grouped according to whether they received a blood
transfusion during the hospitalization. The association between transfusion
and outcome was assessed using Cox proportional hazards modeling that incorporated
transfusion as a time-dependent covariate and the propensity to receive blood,
and a landmark analysis.Main Outcome MeasureThirty-day mortality.ResultsOf the patients included, 2401 (10.0%) underwent at least 1 blood transfusion
during their hospitalization. Patients who underwent transfusion were older
and had more comorbid illness at presentation and also had a significantly
higher unadjusted rate of 30-day death (8.00% vs 3.08%; P<.001), myocardial infarction (MI) (25.16% vs 8.16%; P<.001), and death/MI (29.24% vs 10.02%; P<.001)
compared with patients who did not undergo transfusion. Using Cox proportional
hazards modeling that incorporated transfusion as a time-dependent covariate,
transfusion was associated with an increased hazard for 30-day death (adjusted
hazard ratio [HR], 3.94; 95% confidence interval [CI], 3.26-4.75) and 30-day
death/MI (HR, 2.92; 95% CI, 2.55-3.35). In the landmark analysis that included
procedures and bleeding events, transfusion was associated with a trend toward
increased mortality. The predicted probability of 30-day death was higher
with transfusion at nadir hematocrit values above 25%.ConclusionsBlood transfusion in the setting of acute coronary syndromes is associated
with higher mortality, and this relationship persists after adjustment for
other predictive factors and timing of events. Given the limitations of post
hoc analysis of clinical trials data, a randomized trial of transfusion strategies
is warranted to resolve the disparity in results between our study and other
observational studies. We suggest caution regarding the routine use of blood
transfusion to maintain arbitrary hematocrit levels in stable patients with
ischemic heart disease.
979 citations
TL;DR: Glycoprotein IIb/IIIa inhibitors reduce the occurrence of death or myocardial infarction in patients with acute coronary syndromes not routinely scheduled for early revascularisation, and the event reduction is greatest in patients at high risk of thrombotic complications.
922 citations
TL;DR: The American College of Cardiology Foundation (ACCF) Task Force on Clinical Expert Consensus Documents (ECDs) as mentioned in this paper developed by the ACCF and other cosponsors are intended to inform practitioners, payers, and other interested parties of the opinion of the ACC and document cosponsors concerning evolving areas of clinical practice and/or technologies that are widely available or new to the practice community.
Abstract: This document has been developed by the American College of Cardiology Foundation (ACCF) Task Force on Clinical Expert Consensus Documents, the American College of Gastroenterology (ACG), and the American Heart Association (AHA). Expert consensus documents (ECDs) are intended to inform practitioners, payers, and other interested parties of the opinion of the ACCF and document cosponsors concerning evolving areas of clinical practice and/or technologies that are widely available or new to the practice community. Topics chosen for coverage by ECDs are so designed because the evidence base, the experience with technology, and/or the clinical practice are not considered sufficiently well developed to be evaluated by the formal American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines process. Often the topic is the subject of ongoing investigation. Thus, the reader should view ECDs as the best attempt of the ACCF and other cosponsors to inform and guide clinical practice in areas where rigorous evidence may not be available or the evidence to date is not widely accepted. When feasible, ECDs include indications or contraindications. Topics covered by ECDs may be addressed subsequently by the ACC/AHA Practice Guidelines Committee as new evidence evolves and is evaluated.
The Task Force on ECDs makes every …
824 citations
TL;DR: Patients with acute MI of <12 hours’ duration were randomized to placebo or abciximab if they were deemed candidates for primary PTCA, and the primary efficacy end point was death, reinfarction, or any (urgent or elective) target vessel revascularization (TVR) at 6 months by intention-to-treat (ITT) analysis.
Abstract: Background—The benefit of catheter-based reperfusion for acute myocardial infarction (MI) is limited by a 5% to 15% incidence of in-hospital major ischemic events, usually caused by infarct artery reocclusion, and a 20% to 40% need for repeat percutaneous or surgical revascularization. Platelets play a key role in the process of early infarct artery reocclusion, but inhibition of aggregation via the glycoprotein IIb/IIIa receptor has not been prospectively evaluated in the setting of acute MI. Methods and Results—Patients with acute MI of <12 hours’ duration were randomized, on a double-blind basis, to placebo or abciximab if they were deemed candidates for primary PTCA. The primary efficacy end point was death, reinfarction, or any (urgent or elective) target vessel revascularization (TVR) at 6 months by intention-to-treat (ITT) analysis. Other key prespecified end points were early (7 and 30 days) death, reinfarction, or urgent TVR. The baseline clinical and angiographic variables of the 483 (242 placeb...
692 citations
TL;DR: The findings demonstrated that tirofiban offered less protection from major ischemic events than did abciximab, and the relative benefit of abcximab was consistent regardless of age, sex, the presence of diabetes, or the presence or absence of pretreatment with clopidogrel.
Abstract: Background In the setting of percutaneous coronary revascularization, agents in the class known as platelet glycoprotein IIb/IIIa inhibitors have significantly reduced the incidence of death or nonfatal myocardial infarction at 30 days. We assessed whether there are differences in safety or efficacy between two such inhibitors, tirofiban and abciximab. Methods Using a double-blind, double-dummy design at 149 hospitals in 18 countries, we randomly assigned patients to receive either tirofiban or abciximab before undergoing percutaneous coronary revascularization with the intent to perform stenting. The primary end point was a composite of death, nonfatal myocardial infarction, or urgent target-vessel revascularization at 30 days. The trial was designed and statistically powered to demonstrate the noninferiority of tirofiban as compared with abciximab. Results The primary end point occurred more frequently among the 2398 patients in the tirofiban group than among the 2411 patients in the abciximab group (7....
662 citations
Cited by
More filters
TL;DR: The once-in-a-lifetime treatment with Abciximab Intracoronary for acute coronary syndrome and a second dose intravenously for atrial fibrillation is recommended for adults with high blood pressure.
Abstract: ACE
: angiotensin-converting enzyme
ACS
: acute coronary syndrome
ADP
: adenosine diphosphate
AF
: atrial fibrillation
AMI
: acute myocardial infarction
AV
: atrioventricular
AIDA-4
: Abciximab Intracoronary vs. intravenously Drug Application
APACHE II
: Acute Physiology Aand Chronic
7,519 citations
TL;DR: This document summarizes current research, plans, and recommendations for future research, as well as providing a history of the field and some of the techniques used, currently in use, at the National Institutes of Health.
Abstract: Jeffrey L. Anderson, MD, FACC, FAHA, Chair
Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect
Nancy M. Albert, PhD, RN, FAHA
Biykem Bozkurt, MD, PhD, FACC, FAHA
Ralph G. Brindis, MD, MPH, MACC
Mark A. Creager, MD, FACC, FAHA[#][1]
Lesley H. Curtis, PhD, FAHA
David DeMets, PhD[#][1]
Robert A
6,967 citations
TL;DR: The current guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation are based on the findings of the ESC Task Force on 12 March 2015.
Abstract: ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).
6,866 citations
TL;DR: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation are published.
Abstract: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)
6,599 citations
TL;DR: Authors/Task Force Members: John J. McMurray (Chairperson) (UK), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Angelo Auricchio (Switzerland), Michael Böhm ( Germany), Kenneth Dickstein (Norway), Volkmar Falk (Sw Switzerland), Gerasimos Filippatos (G Greece), Cândida Fonseca (Portugal), Miguel Angel Gomez-Sanchez (Spain).
Abstract: Authors/Task Force Members: John J.V. McMurray (Chairperson) (UK)*, Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Angelo Auricchio (Switzerland), Michael Böhm (Germany), Kenneth Dickstein (Norway), Volkmar Falk (Switzerland), Gerasimos Filippatos (Greece), Cândida Fonseca (Portugal), Miguel Angel Gomez-Sanchez (Spain), Tiny Jaarsma (Sweden), Lars Køber (Denmark), Gregory Y.H. Lip (UK), Aldo Pietro Maggioni (Italy), Alexander Parkhomenko (Ukraine), Burkert M. Pieske (Austria), Bogdan A. Popescu (Romania), Per K. Rønnevik (Norway), Frans H. Rutten (The Netherlands), Juerg Schwitter (Switzerland), Petar Seferovic (Serbia), Janina Stepinska (Poland), Pedro T. Trindade (Switzerland), Adriaan A. Voors (The Netherlands), Faiez Zannad (France), Andreas Zeiher (Germany).
6,367 citations