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  • JAMA August 8, 2017

    Figure 2: Distribution of Volume of Infarcted Brain Tissue by Randomization Group Observed on the Day 7 Diffusion-Weighted MRI Scan

    Panels A and B depict the cumulative distribution of observed infarct volume up to the 90th percentile for each treatment group compared with the control group. The y-axis gives the percentage of patients with an observed total infarct volume less than or equal to that of the corresponding infarct volume on the x-axis. IQR indicates interquartile range; MRI, magnetic resonance imaging.
  • Acute Stroke Intervention: A Systematic Review

    Abstract Full Text
    JAMA. 2015; 313(14):1451-1462. doi: 10.1001/jama.2015.3058

    This systematic review summarizes the pathophysiology of acute brain ischemia and infarction and available reperfusion treatments.

  • JAMA April 14, 2015

    Figure 1: Regions of Cerebral Hypoperfusion Following Acute Ischemic Stroke

    MRI indicates magnetic resonance imaging. A, Schematic representation of regions of hypoperfused brain tissue following acute occlusion of the middle cerebral artery. The ischemic core is an area of irreversible ischemia and cell death; ischemic penumbra, potentially salvageable tissue with prompt reperfusion; benign oligemia, decreased perfusion but no infarction risk regardless of treatment. The infarct core can enlarge into the penumbra if reperfusion is not successful. B, Top, Axial diffusion-weighted MRI (DWI) showing a hyperintensity consistent with irreversible ischemia (ischemic core) in the deep perforating territory of the right middle cerebral artery affecting the caudate, internal capsule, and lentiform nucleus. Bottom, Axial perfusion-weighted MRI (PWI) at the same level as the DWI showed a much larger area of hypoperfusion. Perfusion-weighted imaging uses contrast material to estimate cerebral blood flow. The color scale represents mean transit time of a contrast bolus; blue indicates normal transit time and shades of green, yellow, orange, and red indicate delay in transit time (ischemia). The region of the ischemic core as defined in the DWI shows areas of no contrast (black) in the PWI, indicative of irreversible injury. The area with abnormal transit time surrounding the core is considered the ischemic penumbra. These images are from a 49-year-old patient who presented with sudden onset of dysarthria and left hemiparesis. The MRI images were obtained following intravenous recombinant tissue plasminogen activator administered approximately 50 minutes after symptom onset to assess eligibility for mechanical thrombectomy.
  • JAMA November 19, 2014

    Figure 1: Extent, Distribution, and Location of Obstructive Non–Infarct-Related Artery Disease Among Patients With ST-Elevation Myocardial Infarction

    Obstructive coronary artery disease was defined as more than 50% stenosis in major epicardial coronary artery.aThe data are from the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) I trial, the GUSTO IIb trial, the GUSTO III trial, the Integrilin to Minimise Platelet Aggregation and Coronary Thrombus in Acute Myocardial Infarction (IMPACT-AMI) trial, the GUSTO V trial, the Integrilin and Tenecteplase in Acute Myocardial Infarction (INTEGRITI) trial, the Caldaret in ST Elevation Myocardial Infarction (CASTEMI) trial, and the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX AMI) trial.bPresence or absence of obstructive coronary artery disease on each vessel territory (LAD, LCX, RCA, or LMCA) was counted. The denominators include patients at risk for non-IRA disease in the specified artery who did not have missing data on angiogram-estimated stenosis necessary to determine non-IRA status.
  • JAMA November 19, 2014

    Figure 2: Kaplan-Meier Curve for 30-Day Mortality Between Patients With and Without Obstructive Non–Infarct-Related Artery (Non-IRA) Disease

    Among 28 282 patients, 15 patients with missing information on mortality (6 patients were missing any indication of death and 9 did not have data on time to death) were excluded (n = 28 267).
  • JAMA July 9, 2014

    Figure: Results of a Meta-analysis of the Outcomes of Nonfatal Infarction, Death, and Nonfatal Stroke in Patients Receiving Perioperative β-Blockers

    Abbreviations: BBSA, Beta Blocker in Spinal Anesthesia study; DIPOM, Diabetic Postoperative Mortality and Morbidity trial; MaVS, Metoprolol after Vascular Surgery study; POBBLE, Perioperative β-blockade trial; POISE, Perioperative Ischemic Evaluation trial. Dotted line indicates no effect. Dashed line is centered on meta-analysis pooled estimate.
  • JAMA December 25, 2013

    Figure 1: Multiple Cerebral Infarctions and Intracranial Vessel Abnormalities

    A, Axial MRI using fluid-attenuated inversion recovery (left) demonstrating hyperintense multifocal lesions involving mainly the subcortical white matter; axial diffusion-weighted MRI (right) showing hyperintense lesions consistent with recent infarctions. B, Digital subtraction angiography of the intracranial vessels showing widespread areas of vessel wall irregularity, which consist of zones of focal stenosis and luminal tapering in many third-order and fourth-order branches.
  • JAMA December 12, 2012

    Figure 2: Global Left Ventricular Function and Regional Infarct and Border Zone Wall Motion

    BMC indicates bone marrow mononuclear cell; MI, myocardial infarction.
  • Effect of the Use and Timing of Bone Marrow Mononuclear Cell Delivery on Left Ventricular Function After Acute Myocardial Infarction: The TIME Randomized Trial

    Abstract Full Text
    free access
    JAMA. 2012; 308(22):2380-2389. doi: 10.1001/jama.2012.28726
    Traverse and coauthors for the Cardiovascular Cell Therapy Research Network report on the effect on left ventricular function of the use and timing of bone marrow mononuclear cell delivery after acute myocardial infarction. In an accompanying Editorial, Marbán and Malliaras discuss the mixed results for bone marrow–derived cell therapy for ischemic heart disease.
  • Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction: The INFUSE-AMI Randomized Trial

    Abstract Full Text
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    JAMA. 2012; 307(17):1817-1826. doi: 10.1001/jama.2012.421
    Stone and coauthors investigated whether bolus intracoronary abciximab and manual aspiration thrombectomy reduce infarct size or improve clinical outcomes after primary percutaneous coronary intervention in patients with large anterior ST-segment elevation myocardial infarction.
  • JAMA May 2, 2012

    Figure: Diagram of Patient Flow in the INFUSE-AMI Trial

    More than 1 reason for study exclusion were present in some patients who were not eligible for randomization. Cardiac magnetic resonance imaging (cMRI) at 30 days was not performed in 70 enrolled patients for the following reasons: patient refusal or withdrawn consent for cMRI (n = 27); patient inability to complete the cMRI (most commonly for claustrophobia) (n = 15); death before the 30-day cMRI (n = 13); too ill (n = 4); patient forgot (n = 4); contrast contraindication (n = 2); other (n = 5). In addition, despite being performed, the cMRI study was not evaluable for the primary end point of infarct size in 29 patients because of technical issues in image acquisition, including incorrect image sequencing, inadequate inversion recovery time, excessive breathing artifact, and missing slices. CABG denotes coronary artery bypass graft; GPI, glycoprotein IIb/IIIa inhibitor; IC, intracoronary; LAD, left anterior descending coronary artery; PCI, percutaneous coronary intervention; and TIMI, Thrombolysis in Myocardial Infarction.
  • JAMA November 16, 2011

    Figure 2: Primary End Point Analysis of Global LV Function and Regional Infarct and Border Zone Wall Motions

    LV indicates left ventricular; LVEF, left ventricular ejection fraction; BMCs, bone marrow mononuclear cells; MI, myocardial infarction. Solid and open circles represent the means at baseline and 6 months of BMCs and placebo, respectively, and error bars represent 95% CIs.
  • Effect of Intracoronary Delivery of Autologous Bone Marrow Mononuclear Cells 2 to 3 Weeks Following Acute Myocardial Infarction on Left Ventricular Function: The LateTIME Randomized Trial

    Abstract Full Text
    free access
    JAMA. 2011; 306(19):2110-2119. doi: 10.1001/jama.2011.1670
  • Intra-aortic Balloon Counterpulsation and Infarct Size in Patients With Acute Anterior Myocardial Infarction Without Shock: The CRISP AMI Randomized Trial

    Abstract Full Text
    free access
    JAMA. 2011; 306(12):1329-1337. doi: 10.1001/jama.2011.1280
  • JAMA May 11, 2011

    Figure 2: Comparison of Infarct Size Between Epoetin Alfa and Placebo Groups

    Boxes represent interquartile range, black-filled circles represent means, whiskers represent the minimum and maximum, and horizontal lines represent the median. Individual data points (open circles) are provided for the graph for patients aged 70 years or older due to the low sample sizes. For patients aged 70 years or older, the P value is equal to .03 for the comparison of epoetin alfa with placebo for the first cardiac magnetic resonance (CMR) imaging. LV indicates left ventricular.
  • Intravenous Erythropoietin in Patients With ST-Segment Elevation Myocardial Infarction: REVEAL: A Randomized Controlled Trial

    Abstract Full Text
    free access
    JAMA. 2011; 305(18):1863-1872. doi: 10.1001/jama.2011.592
  • Evaluation of Agents to Reduce Infarct Size: It Can Be Quite REVEALing

    Abstract Full Text
    JAMA. 2011; 305(18):1908-1909. doi: 10.1001/jama.2011.600
  • JAMA February 9, 2011

    Figure 2: Unadjusted 30-Day Mortality

    Creatine kinase MB (CK-MB) ratios are derived from the pooled coronary artery bypass graft surgery trials. The troponin I ratios are derived from the Pexelizumab for the Reduction of Infarction and Mortality in Coronary Artery Bypass Graft Surgery I and II trials. Data markers represent the mortality rates within each category. The error bars represent 95% confidence intervals.
  • The Need for Large-Scale Randomized Evidence Without Undue Emphasis on Small Trials, Meta-analyses, or Subgroup Analyses

    Abstract Full Text
    JAMA. 2009; 302(21):2361-2362. doi: 10.1001/jama.2009.1756