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Biomedical subjects

T J Ryan

Publications and source records attributed to T J Ryan.

At least 235 records · Page 13Linked to original sources
PubMed1988

Risk of developing an acute myocardial infarction or sudden coronary death in patients with exercise-induced silent myocardial ischemia. A report from the Coronary Artery Surgery Study (CASS) registry.

To evaluate whether patients with silent myocardial ischemia during exercise testing are at increased risk for developing a subsequent acute myocardial infarction or sudden death, the data on 424 such patients with proven coronary artery disease (CAD) from the Coronary Artery Surgery Study (CASS) registry were analyzed. These patients (group 1) were compared with 456 other patients with CAD (group 2) who had both ischemic ST depression and angina pectoris during exercise testing and with 1,019 control patients without CAD. The probability of remaining free of a subsequent acute myocardial infarction or sudden death at 7 years was 80 and 91%, respectively, for group 1, 82 and 93%, respectively, for group 2 (difference not significant, compared with group 1), and 98 and 99%, respectively, for the control patients (p less than 0.001), compared with group 1 or 2). Among patients in group 1, the probability of remaining free of myocardial infarction and sudden death at 7 years was related to the severity of CAD and presence of left ventricular (LV) dysfunction, and ranged from 90% for patients with 1-vessel CAD and preserved LV function to 38% for patients with 3-vessel CAD and abnormal LV function (p less than 0.001). Thus, patients with either silent or symptomatic ischemia during exercise testing have a similar risk of developing an acute myocardial infarction or sudden death--except in the 3-vessel CAD subgroup, where the risk is greater in silent ischemia. The risk of patients with silent myocardial ischemia is based primarily on angiographic variables.

Adult↗
PubMed1988

Comparison of effects of medical and surgical therapy on survival in severe angina pectoris and two-vessel coronary artery disease with and without left ventricular dysfunction: a Coronary Artery Surgery Study Registry Study.

This nonrandomized study compared the results of early coronary artery bypass grafting to those of initial medical therapy in a group of 2,023 patients with severe angina pectoris and 2 major epicardial coronary arteries having greater than or equal to 70% diameter luminal narrowing. Medical therapy was selected for 706 patients, and 1,317 patients were treated by coronary artery bypass grafting. The 6-year survival rate was 76% for patients treated medically and 89% for patients treated surgically (p less than 0.0001). Cox multivariate analysis showed that surgical treatment was a beneficial independent predictor of survival (p less than 0.001). For patients with 2-vessel coronary artery disease who had Canadian Heart Association class III and IV angina at presentation, surgical therapy provided a survival advantage for patients with impaired left ventricular function and proximal narrowing of 1 or more coronary arteries.

Acute Disease↗
PubMed1988

Comparison of coronary artery bypass surgery and medical therapy in patients with exercised-induced silent myocardial ischemia: a report from the Coronary Artery Surgery Study (CASS) registry.

To determine whether coronary artery bypass surgery would prolong survival in patients with silent myocardial ischemia during exercise testing, the data on 692 such patients from the Coronary Artery Surgery Study (CASS) registry were analyzed. The patients were followed up for up to 7 years after medical (n = 424) or surgical (n = 268) therapy. Stratification of patients into subsets was based on the results of cardiac catheterization. Surgical benefit was greatest in the patients with three vessel coronary artery disease or abnormal left ventricular function. Among the 75 patients with three vessel coronary disease and left ventricular dysfunction, the 7 year survival rate was 37% for the medical group and 90% for the surgical group (p less than 0.0001). Thus, among patients with silent myocardial ischemia during exercise testing in this nonrandomized study, survival appeared to be enhanced by coronary artery bypass surgery in subsets of patients with severe coronary artery disease and abnormal left ventricular function.

Coronary Artery Bypass↗
PubMed1988

Time to first new myocardial infarction in patients with severe angina and three-vessel disease comparing medical and early surgical therapy: a CASS registry study of survival.

We compared time to first new myocardial infarction during a 6-year follow-up in patients in the registry of the Coronary Artery Surgery Study who had three-vessel coronary artery disease and Canadian Cardiovascular Society Class III-IV angina pectoris. There were 679 medically treated patients and 1921 surgically treated patients in this nonrandomized comparison. A broad definition of myocardial infarction incorporating electrocardiographic and clinical criteria was used to include as many new infarctions as possible. Patients were stratified by left ventricular wall motion score and number of proximal coronary artery stenoses; after adjustment for these variables, 86% of surgical and 73% of medical patients were free of new myocardial infarction at 6 years (p less than 0.0001). This advantage of surgical treatment was observed in subgroups of patients with at least one proximal 70% (or greater) stenosis in the left anterior descending coronary artery and moderate or severe impairment of left ventricular function, as well as those patients with two proximal coronary artery narrowings. In a multivariate (Cox) analysis of preoperative clinical, hemodynamic, and angiographic factors, early operation was the strongest predictor of freedom from new myocardial infarction.

Angina Pectoris↗
PubMed1987

A fibroblast-derived urokinase-inhibitor differing from protease nexin.

UK-I, a 60-kDa urokinase-inhibitor derived from human fibroblasts, inhibited 54-kDa urokinase (EC 3.4.21.31) activity dose-dependently on ordinary fibrin-agar autograms. This UK-I formed an SDS-stable approximately 75-kDa complex with radioiodinated urokinase (33 kDa) on an autoradiogram following SDS/polyacrylamide gel electrophoresis. Benzamidine hydrochloride inhibited its formation, indicating UK-I to bind at the active site of urokinase and form an inactive complex. UK-I did not form a complex with [125I]thrombin (EC 3.4.21.5). It is thus evident that UK-I is one type of urokinase-inhibitor derived from human fibroblasts with properties differing from protease nexin, another urokinase-inhibitor derived from the same source.

Amyloid beta-Protein Precursor↗
PubMed1987

Value of exercise testing in determining the risk classification and the response to coronary artery bypass grafting in three-vessel coronary artery disease: a report from the Coronary Artery Surgery Study (CASS) registry.

To determine whether exercise testing can identify higher risk patients with 3-vessel coronary artery disease (CAD) whose survival might be prolonged by coronary artery bypass grafting (CABG), the results of CABG were compared with those of medical therapy in 1,249 nonrandomized patients with 3-vessel CAD from the Coronary Artery Surgery Study (CASS) registry who underwent exercise testing. Analysis of 28 variables by Cox's regression model for survival revealed an independent effect of the left ventricular (LV) score, the final exercise stage, and treatment received on survival. Seven-year survival rates between medical and surgical therapy were compared among subsets of patients according to the LV function and the results of exercise testing. Among patients with normal LV function, those with at least 1 mm of ischemic ST-segment depression or low exercise capacity had better 7-year survival if treated by surgical rather than medical therapy (p less than 0.05). Survival was not different between the medical and surgical groups in patients without ischemic ST depression or with good exercise capacity. Among patients with impaired LV function, surgery improved survival in most subsets of patients with the exception of patients with a preserved exercise capacity. These results support the use of exercise testing in the risk stratification of patients with 3-vessel CAD.

Clinical Trials as Topic↗
PubMed1987

Significance of silent myocardial ischemia during exercise testing in patients with coronary artery disease.

To evaluate the significance of ischemic ST-segment depression without associated chest pain during exercise testing, data were analyzed from 2,982 patients from the Coronary Artery Surgery Study (CASS) registry who underwent coronary arteriography and exercise testing and were followed up for 7 years. Patients with proved coronary artery disease (CAD) (at least 70% diameter narrowing) were grouped according to whether they had at least 1 mm of ST-segment depression or anginal chest pain during exercise testing. Four hundred twenty-four had ischemic ST depression without angina (group 1); 232 had angina but no ischemic ST depression (group 2); 456 had both ischemic ST depression and angina (group 3); and 471 had neither ischemic ST depression nor angina (group 4). Sixty-three percent of patients in group 1 and 55% in group 2 had multivessel CAD (difference not significant). The 7-year survival rates were similar for patients in groups 1 (76%), 2 (77%), and 3 (78%), but were significantly better for patients in group 4 (88%, p less than 0.001). Among group 1 patients, survival was related to severity of CAD (p less than 0.001). The 7-year survival rate in group 1 was significantly worse than that in a separate group of 282 patients with ischemic ST depression without angina during exercise testing who had no CAD (95% survival, p less than 0.001). Thus, in patients with silent myocardial ischemia during exercise testing, the extent of CAD and the 7-year survival rate are similar to those of patients with angina during exercise testing. Prognosis is determined primarily by the severity of CAD. In patients without CAD, the survival rate is excellent.

Angina Pectoris↗
PubMed1987

Carotid hemorrhage: a complication of peritonsillar abscess.

Carotid hemorrhage secondary to peritonsillar abscess occurs infrequently today because of the effectiveness of antibiotic therapy. When it does occur, however, emergency physicians unfamiliar with such a complication may have difficulty making its diagnosis and instituting appropriate therapy. Prevention is the easiest way to treat septic erosion. Abscesses are treated best with penicillin or, in the allergic patient, clindamycin followed by incision and drainage. Once the abscess has eroded into the carotid artery, it usually must be tied off to control the subsequent massive bleeding.

Adolescent↗