Abstract:Achieving early reperfusion with thrombolytic agents or primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) is the cornerstone of current therapy. Two advances in pharmacologic therapy are: (1) bolus thrombolysis, which simplifies therapy, reduces door-to-needle time, and reduces the potential for medication errors, and (2) Low-dose fibrinolytic therapy combined with a glycoprotein (GP) IIb/IIIa inhibitor which can achieve higher rates of reperfusion than fibrino… Show more
“…Considering the diverse operational frameworks of emergency systems and healthcare facilities across different countries and regions, localized efforts are essential. Analogous to the time benchmarks set for STEMI (ST-elevation myocardial infarction), where the interval from door to balloon insertion serves as a quality control [ 48 , 49 ], and a similar principle should be applied to ECPR. Fig.…”
“…Considering the diverse operational frameworks of emergency systems and healthcare facilities across different countries and regions, localized efforts are essential. Analogous to the time benchmarks set for STEMI (ST-elevation myocardial infarction), where the interval from door to balloon insertion serves as a quality control [ 48 , 49 ], and a similar principle should be applied to ECPR. Fig.…”
“…The initial health status of patients and final goals for concomitant prescription of exercise and SGLT2 inhibition may need to be considered carefully prior to commencement. (Cannon et al;2014). The mechanisms behind this phenomenon are unclear but increased oxidative ATP synthesis (ATP Ox ) and mitochondrial uncoupling are two leading hypotheses.…”
Using a traditional random-effects model, a recent metaanalysis by Herrod et al. (2018) reported statistically significant reductions in both resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) as a result of aerobic, resistance, and combined aerobic and resistance exercise in adults with a mean age of 65 years and older. However, a recently proposed and alternative method, the inverse heterogeneity model (IVhet), has been shown to provide more robust findings. The purpose of this study was to apply the IVhet model to these previous meta-analytic findings. METHODS: Data from 44 randomized controlled trials representing 92 groups (48 exercise, 44 control) were pooled using the IVhet model. In addition, absolute and relative differences between the IVhet and random-effects model were calculated. Data were reported using the mean difference (exercise minus control) with nonoverlapping 95% confidence intervals considered statistically significant. RESULTS: Using the IVhet model, statistically significant reductions in resting blood pressure were found as a result of aerobic exercise (SBP,-4.7 mmHg, 95% CI,-7.7 to-1.8; DBP,-2.0 mmHg, 95% CI-3.13 to-0.89), SBP but not DBP for resistance training (SBP,-7.0 mmHg, 95% CI,-10.5 to-3.4; DBP,-1.2 mmHg, 95% CI-2.7 to 0.31), and both SBP and DBP for combined aerobic and resistance training (SBP,-5.5 mmHg, 95% CI,-8.3 to-2.7; DBP,-3.7 mmHg, 95% CI-4.8 to-2.7). When compared to the random-effects model, findings from four of the six mean differences in blood pressure were smaller, ranging from-0.82 to-0.19 mmHg (6.1% to 41.0%) while all six 95% CI were wider, ranging from 0.24 to 1.56 mmHg (11.5% to 36.8%). CONCLUSIONS: These findings suggest that with the exception of changes in DBP as a result of resistance training, exercise (aerobic, resistance, combined aerobic and resistance) reduces resting SBP and DBP in older adults. Importantly, these findings are generally smaller than those previously reported, a factor that could have practical implications. Future studies should consider using the IVhet model when conducting an aggregate data meta-analysis.
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