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Julian DG. Are antianginal drugs effective in secondary prevention after myocardial infarction? Eur Heart J 1995; 16 Suppl E:38-40. [PMID: 8542880 DOI: 10.1093/eurheartj/16.suppl_e.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Julian DG. Should ACE inhibitors be administered to all patients after acute myocardial infarction? A (cautious) negative response. Eur Heart J 1995; 16 Suppl E:44-5. [PMID: 8542882 DOI: 10.1093/eurheartj/16.suppl_e.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Julian DG. Secondary prophylaxis after myocardial infarction. BMJ (CLINICAL RESEARCH ED.) 1995; 310:61. [PMID: 7827574 PMCID: PMC2548465 DOI: 10.1136/bmj.310.6971.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Julian DG. GISSI-3. Lancet 1994; 344:203. [PMID: 7912804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Julian DG. Foreword. Eur Heart J 1994. [DOI: 10.1093/eurheartj/15.suppl_b.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schwartz PJ, Camm AJ, Frangin G, Janse MJ, Julian DG, Simon P. Does amiodarone reduce sudden death and cardiac mortality after myocardial infarction? The European Myocardial Infarct Amiodarone Trial (EMIAT). Eur Heart J 1994; 15:620-4. [PMID: 8056000 DOI: 10.1093/oxfordjournals.eurheartj.a060557] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Weston CF, Penny WJ, Julian DG. Guidelines for the early management of patients with myocardial infarction. British Heart Foundation Working Group. BMJ (CLINICAL RESEARCH ED.) 1994; 308:767-71. [PMID: 8142834 PMCID: PMC2539628 DOI: 10.1136/bmj.308.6931.767] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In light of recent publications relating to resuscitation and pre-hospital treatment of patients suffering acute myocardial infarction of British Heart Foundation convened a working group to prepare guidelines outlining the responsibilities of general practitioners, ambulance services, and admitting hospitals. The guidelines emphasise the importance of the rapid provision of basic and advanced life support; adequate analgesia; accurate diagnosis; and, when indicted, thrombolytic treatment. The working group developed a standard whereby patients with acute myocardial infarction should receive thrombolysis, when appropriate, within 90 minutes of alerting the medical or ambulance service--the call to needle time. Depending on local circumstances, achieving this standard may involve direct admissions to coronary care units, "fast track" assessments in emergency departments, or pre-hospital thrombolytic treatment started by properly equipped and trained general practitioners.
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Ball SG, Julian DG. ACE inhibitors and heart failure. Lancet 1992; 339:687-8. [PMID: 1347387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
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Abstract
There is abundant evidence from angiographic studies that reperfusion and/or patency rates are greater when thrombolysis is initiated earlier. Evidence of a reduction in infarct size has been provided by a number of studies, which have also suggested that earlier therapy preserves left ventricular function. The major intravenous thrombolytic mortality trials appear to confirm the importance of delivering therapy soon after the onset of symptoms e.g. GISSI and ISIS-2. However, the benefit reported in the first hour in GISSI may be questioned. Furthermore, it seems probable that those coming in late to trials are patients who did not have a sudden onset of symptoms, but whose symptoms persisted, perhaps with recurrent pain, or with heart failure symptoms. This may account for the fact that the benefit seen relatively late, particularly in ISIS-2, does not seem to accord with reperfusion, infarct size and LVEF findings. The true benefits of earlier therapy will be established only when patients are randomized to active therapy or placebo at one point in time and then switched to alternative therapy at a specified later time. This has been done in a small trial with alteplase in Belfast. The findings were suggestive but not conclusive of an improvement in LVEF in those treated earlier. The European Myocardial Infarction Project (EMIP) should go far towards answering the question. In most European cities the time between onset of symptoms and the initiation of skilled treatment for myocardial infarction is of the order of 5-6 h.(ABSTRACT TRUNCATED AT 250 WORDS)
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Julian DG. The APSAC interventional mortality study (AIMS) trial: mortality data. Clin Cardiol 1990; Suppl 5:V20-1; discussion V27-32. [PMID: 2182236 DOI: 10.1002/clc.4960131306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The anistreplase (anisoylated plasminogen streptokinase activator complex or APSAC) intervention mortality study was designed as a double-blind, placebo-controlled study to test the effectiveness of anistreplase, 30 U administered intravenously within the first 6 hours of acute myocardial infarction. The primary endpoint of the study was mortality of all causes at 30 days and 1 year. Within 30 days, there were 77 deaths with placebo (17.8%) and 40 deaths (6.5%) with anistreplase, an odds reduction of 50.5% (p = 0.0006). By the end of one year, there had been a total of 113 deaths (17.8%) with placebo and 69 deaths (11.1%) with anistreplase, an odds reduction of 42.7% (p = 0.0007).
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Julian DG. Increased survival after APSAC: 30-day and 12-month mortality data from the APSAC Intervention Mortality Study. Am J Cardiol 1989; 64:27A-29A; discussion 41A-42A. [PMID: 2662740 DOI: 10.1016/0002-9149(89)90926-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Preliminary analysis of mortality data from the anisoylated plasminogen streptokinase activator complex (APSAC) Intervention Mortality Study (AIMS) showed a 47% reduction in 30-day mortality (with a 95% confidence interval of 21 to 65%) for patients treated with APSAC within 6 hours of onset of acute myocardial infarction. After follow-up of 1,004 patients for 30 days after randomization in the double-blind, placebo-controlled, clinical trial, researchers found that 61 patients (12.2%) in the placebo group had died compared with 32 patients (6.4%) in the APSAC group (p = 0.0016). Incomplete follow-up of these patients for 1 year provided an estimated mortality of 19.4% in the placebo group and 10.8% in the APSAC group (log-rank test for survival to year p = 0.0006). Benefit was seen irrespective of age, site of infarction and time from onset of symptoms up to 6 hours.
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Shaw PJ, Bates D, Cartlidge NE, French JM, Heaviside D, Julian DG, Shaw DA. An analysis of factors predisposing to neurological injury in patients undergoing coronary bypass operations. THE QUARTERLY JOURNAL OF MEDICINE 1989; 72:633-46. [PMID: 2608882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In a prospective study of 312 patients undergoing elective coronary bypass surgery we evaluated 50 preoperative, intraoperative and postoperative factors with the aim of identifying predisposing causes for perioperative neurological morbidity. Factors which showed a significant association with the development of neurological complications included the duration and severity of heart disease before surgery; the presence of extracoronary vascular disease; history of cardiac failure; history of diabetes; difficulty in terminating bypass; intraoperative mean arterial pressure levels of less than 40 mmHg; a large drop in haemoglobin level during surgery; prolonged stay in the intensive therapy unit after operation; and abnormalities of blood pressure control in the postoperative period. The significance of these findings is discussed and a comparison made with data available from previous studies.
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Julian DG, Pentecost BL, Chamberlain DA. A milestone for myocardial infarction. BMJ (CLINICAL RESEARCH ED.) 1988; 297:497-8. [PMID: 3139173 PMCID: PMC1840377 DOI: 10.1136/bmj.297.6647.497] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Fuster V, Julian DG. Ischaemic heart disease Overview. Curr Opin Cardiol 1988. [DOI: 10.1097/00001573-198807000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hugenholtz PG, Julian DG. Introduction. Eur Heart J 1988. [DOI: 10.1093/eurheartj/9.suppl_a.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Julian DG, Simpson JM, Cadigan PJ, Petri MC, Hall RJ, Smith RH, Pentecost BL. A controlled trial of GL enzyme in the treatment of acute myocardial infarction. Cardiology 1988; 75:177-83. [PMID: 3046747 DOI: 10.1159/000174368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
GL enzyme (hyaglosidase) is a highly purified component enzyme of hyaluronidase. A therapeutic trial was carried out in the treatment of suspected myocardial infarction among 1,488 patients presenting within 6 h of the onset of symptoms. No significant reduction in mortality at 6 months was observed in the GL group (15.7%) compared with the placebo group (16.4%). Mortality at 2 weeks was also unaffected by treatment (GL 10.3%; placebo 10.9%).
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Julian DG, Kulbertus H, Goldstein S, Lubsen J. Invited discussions. Eur Heart J 1987. [DOI: 10.1093/eurheartj/8.suppl_h.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Julian DG. Points: Coronary angioplasty. West J Med 1987. [DOI: 10.1136/bmj.295.6599.675-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
This investigation assesses the extent of tolerance development with nitroglycerin patches and whether tolerance might be prevented by overnight patch removal. On commencing therapy, active patches significantly prolonged exercise time (3.5 hours after patch application) in comparison with placebo, with an accompanying reduction in ST-segment depression at maximal common workload. Patients then received continuous or 12-hour-daily intermittent patch therapy, in a double-blind fashion, for 7 days. Exercise testing was repeated before and after active patch application, on the eighth day of each treatment phase. During continuous therapy, beneficial effects on exercise time and ST depression were abolished. By contrast, during intermittent therapy, prolongation of exercise time and reduction in ST-segment depression still occurred, on testing 3.5 hours after active patch application. These results confirm previous studies showing a high degree of tolerance during continuous therapy with nitroglycerin patches and suggest that tolerance can be prevented by 12-hour-daily intermittent therapy.
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Shaw PJ, Bates D, Cartlidge NE, French JM, Heaviside D, Julian DG, Shaw DA. Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery. Stroke 1987; 18:700-7. [PMID: 3496690 DOI: 10.1161/01.str.18.4.700] [Citation(s) in RCA: 342] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
As part of a prospective study of the neurologic and neuropsychological complications of coronary artery bypass graft surgery, 312 patients were compared with a control group of 50 patients undergoing major surgery for peripheral vascular disease. The purpose of comparing the 2 groups was to determine to what extent neurologic complications after heart surgery can be attributed to cardiopulmonary bypass. The 2 groups were similar with respect to age, preoperative neurologic and intellectual status, anesthetic methods, duration of operation, perioperative complications, and time spent in the intensive therapy unit. Certain potential risk factors for cerebrovascular disease were more common in the control than the coronary bypass patients. The important difference between the 2 groups was that only the latter group underwent cardiopulmonary bypass. In this group 191 of 312 (61%) and 235 of 298 (79%), respectively, developed early neurologic and neuropsychological complications. By the time of hospital discharge 17% had neurologic disability and 38% had significant neuropsychological symptoms. In the control group 9 of 50 (18%) developed neurologic complications resulting largely from trauma to lower limb sensory nerves. Two patients developed primitive reflexes. Fifteen of 48 (31%) showed neuropsychological impairment on 1 or 2 subtest scores. Moderate or severe intellectual dysfunction was not seen in the control patients in contrast to the 24% thus affected in the coronary bypass group. The difference in frequency and severity of central nervous system complications between the 2 groups is likely to reflect cerebral injury resulting from cardiopulmonary bypass.
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