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Biomedical subjects

B Gersh

Publications and source records attributed to B Gersh.

8 recordsLinked to original sources
PubMed1998

The open-artery hypothesis.

Early reperfusion of an infarct-related coronary artery results in myocardial salvage, with subsequent improvement in left ventricular function and survival. However, late reperfusion, which occurs at a time when myocardial salvage is no longer possible, still exerts a favorable impact on left ventricular function and survival. This concept is known as the open-artery hypothesis. Possible mechanisms for this benefit include improved infarct healing, limitation of ventricular remodeling, decreased ventricular arrhythmias, and reperfusion of hibernating myocardium. Although an open infarct-related coronary artery is crucial, it has not been proven that opening an occluded coronary artery using angioplasty is beneficial. A large randomized clinical trial is clearly needed.

Angioplasty, Balloon, Coronary↗
PubMed1991

Sex differences in the management of coronary artery disease. Survival and Ventricular Enlargement Investigators.

BACKGROUND: Despite the fact that coronary artery disease is the leading cause of death among women, previous studies have suggested that physicians are less likely to pursue an aggressive approach to coronary artery disease in women than in men. To define this issue further, we compared the care previously received by men and women who were enrolled in a large postinfarction intervention trial. METHODS: We assessed the nature and severity of anginal symptoms and the use of antianginal and antiischemic interventions before enrollment in the 1842 men and 389 women with left ventricular ejection fractions less than or equal to 40 percent after an acute myocardial infarction who were randomized in the Survival and Ventricular Enlargement trial. RESULTS: Before their index infarction, women were as likely as men to have had angina and to have been treated with antianginal drugs. However, despite reports by women of symptoms consistent with greater functional disability from angina, fewer women had undergone cardiac catheterization (15.4 percent of women vs. 27.3 percent of men, P less than 0.001) or coronary bypass surgery (5.9 percent of women vs. 12.7 percent of men, P less than 0.001). When these differences were adjusted for important covariates, men were still twice as likely to undergo an invasive cardiac procedure as women, but bypass surgery was performed with equal frequency among the men and women who did undergo cardiac catheterization. CONCLUSIONS: Physicians pursue a less aggressive management approach to coronary disease in women than in men, despite greater cardiac disability in women.

Angina Pectoris↗
PubMed1983

Use of survival analysis to determine the clinical significance of new Q waves after coronary bypass surgery.

There are few data on the long-term effects of new Q waves on survival and morbidity after coronary bypass graft surgery (CABG). We followed 1340 patients who underwent CABG in 1978 at 10 hospitals participating in the Coronary Artery Surgery Study (CASS). The incidence of perioperative Q-wave infarction was 4.76% (range 0.0-10.3% by hospital). The rate of infarction was higher in patients who had an increased left ventricular end-diastolic pressure or cardiomegaly on the preoperative chest radiograph. Patients who received more grafts or who had longer cardiopulmonary bypass time were also at higher risk of infarction. In a stepwise discriminant analysis of 44 clinical, angiographic and surgical variables, cardiopulmonary bypass time, topical cardiac hypothermia and cardiomegaly entered the stepwise selection of variables. Long-term survival was adversely affected by the appearance of new postoperative Q waves. The hospital mortality was 9.7% in the 62 patients who had new postoperative Q waves and 1.0% in the 1278 patients who did not (p less than 0.001); the 3-year cumulative survival rates were 85% and 95%, respectively (p less than 0.001). In patients who survived to hospital discharge, the presence of new postoperative Q waves did not adversely affect 3-year survival (94% and 96%, respectively). The survival rates were worse in patients who had a history of infarction or who had impaired left ventricular function preoperatively. The number of readmissions to hospital after CABG among the patients who had a transmural perioperative infarction was similar to to that among patients who did not. We conclude that the appearance of new Q waves after CABG adversely affects survival. The major impact on mortality occurs before hospital discharge. Patients who are destined to have a perioperative infarct cannot be predicted from commonly measured preoperative and angiographic variables.

Adult↗
PubMed1982

The Wolff-Parkinson-White syndrome: a surgical approach.

Twenty-five patients with the preexcitation syndrome underwent operation for ablation of an accessory pathway. The patients were young (mean age 28.1 years) and 20% had congenital heart disease. In 24, markedly symptomatic refractory supraventricular tachycardia had been present for a mean of 12.6 years. The accessory pathway was right or left ventricular free wall in 22 patients and septal in 3 patients. Operation resulted in persistent ablation of the pathway in 80% of the patients. There was no perioperative mortality and no persistent complete heart block. During a mean follow-up of 15.6 months, 83.3% of patients with a preoperative history of supraventricular tachycardia had no recurrence of the arrhythmia. Two patients (8.3%) had macro-reentry paroxysmal supraventricular tachycardia related to a persistently functioning bypass tract. The remaining two patients had supraventricular tachycardia unrelated to a functioning accessory pathway. We conclude that the surgical treatment of patients with preexcitation syndrome (Wolff-Parkinson-White) is safe and effective. It should be considered (1) in patients who are markedly symptomatic with refractory supraventricular tachycardia, (2) in those who have the potential for sudden cardiac death, (3) in younger patients with symptomatic tachycardia in whom there is concern about the long-term effects of antidysrhythmic treatment, and (4) in patients with tachycardia who are undergoing cardiac surgery for repair of associated conditions.

Adolescent↗