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Biomedical subjects

E Gilpin

Publications and source records attributed to E Gilpin.

52 records · Page 3Linked to original sources
PubMed1985

Smoking status at the time of acute myocardial infarction and subsequent prognosis.

A population of 2955 patients admitted to the hospital with acute myocardial infarction (AMI) was followed for 1 year after AMI or until death. Smokers as compared to nonsmokers were over 10 years younger (p less than 0.001) and had a lower prevalence of hypertension (p less than 0.01), congestive heart failure (p less than 0.0001), angina pectoris (p less than 0.01), and diabetes (p less than 0.0001). They had less severe myocardial infarction evidenced, for example, by lower prevalence of pulmonary congestion on chest x-ray (p less than 0.01). Both early (1 month) and late (6 and 12 months) mortality rates were lower in the smoking population (p less than 0.0001 at 1 month, p less than 0.05 at 6 months, and p less than 0.01 at 1 year). Adjusting for age and other variables reduced but did not reverse the survival differential favoring smokers at 1 month, but adjusting for age alone eliminated the differences in mortality rates at 6 and 12 months. We conclude that while smoking is a risk factor for cardiovascular disease and may contribute to the occurrence of AMI at a younger age, smoking at the time of AMI does not appear to be an independent predictor of death during the first year after AMI.

Age Factors↗
PubMed1985

Survival after hospital discharge in matched populations with inferior or anterior myocardial infarction.

Prognostic differences between patients with anterior or inferior myocardial infarction are often related to such variables as previous infarction or the size of the myocardial infarct. We examined the determinants of mortality in 997 hospital survivors of acute Q wave infarction (anterior in 449, inferior in 548) who, although not preselected, were well matched with respect to age, sex and prior infarction or congestive heart failure. Additionally, there was no significant difference in peak serum creatine kinase (CK) between the groups with anterior and inferior infarction (1,459 +/- 1,004 versus 1,357 +/- 1,036). Among the patients with anterior infarction who died during the 1 year follow-up period, 56% died in the first 60 days after hospital discharge compared with 18% of those without inferior infarction (p less than 0.01). Survival curves then became nearly identical at 3 months, and remained so until 1 year when the total mortality rate was 10% for the anterior and 7% for the inferior infarction group (p = NS). Variables associated with heart failure during the hospital phase were more prevalent in anterior infarction, but rales above the scapulae during the hospital stay (p less than 0.0001) and ventricular gallop at the time of discharge (p less than 0.0001) were the top two predictors of 1 year mortality by both univariate and multivariate analysis in inferior infarction. Age (p less than 0.0001) and peripheral edema (p less than 0.0001) were the strongest predictors of mortality in anterior infarction. Previous infarction, although just as common in the group with anterior infarction, was present at 1 year in 48% of nonsurvivors of the group with inferior infarction compared with only 19% of survivors (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Prognosis after extension of myocardial infarct: the role of Q wave or non-Q wave infarction.

We examined whether or not subsets of patients with extension of myocardial infarct were at high risk for early and late mortality. Some data suggest increased risk in patients with non-Q wave infarcts and we hypothesized that infarct extension in this group might be associated with a poorer prognosis than that for patients with extension of Q wave infarcts. A total of 1253 patients with acute myocardial infarction who were included in our data base were followed prospectively. The patients were classified according to electrocardiographic results into the following groups: those with non-Q wave (n = 277) infarcts and those with Q-anterior (n = 462) and Q-inferior (n = 497) infarcts. Extension was diagnosed by two of the following criteria: (1) recurrent chest pain 24 hr or more after admission to the hospital, (2) new persistent electrocardiographic changes, and (3) elevation or reappearance of creatine kinase. By these criteria 85 (6%) patients had extension (8% of non-Q wave infarcts, 6% of Q-anterior infarcts, and 6% of Q-inferior infarcts). Hospital mortality in patients with extension was 15% in those with Q wave infarcts vs 43% in those with non-Q wave infarcts (p less than .01). Nine hundred and fifty-two patients were followed for 1 year. In 24% of those who did not survive 1 year there was extension of infarct; only 6% of survivors had extension (p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

Complex ventricular arrhythmias in patients with Q wave versus non-Q wave myocardial infarction.

We examined whether or not subsets of patients with complex ventricular arrhythmias after myocardial infarction are at high risk with respect to 1 year mortality after hospital discharge. Based on previous studies showing increased risk for those with non-Q wave infarcts, we hypothesized that complex PVCs (premature ventricular complexes) in this group might be associated with a poorer prognosis than complex PVCs in patients with Q wave infarcts. Seven hundred seventy-seven patients entering our study with acute infarction were followed prospectively for 1 year after undergoing a predischarge 24 hr ambulatory electrocardiographic examination. Patients were classified by electrocardiographic criteria into the following groups: Non-Q wave (n = 191), Q wave anterior (n = 261), and Q wave inferior infarction (n = 325). The following arrhythmias were classified as complex: multiform PVCs, couplets, and ventricular tachycardia. Sixty-two percent of patients with non-Q wave infarcts who did not survive 1 year had complex PVCs, compared with 32% of survivors (p less than .01). No differences were seen in the Q wave subgroup. The survival for patients with Q wave and non-Q wave infarction without complex PVCs were nearly identical at 1 year (93% and 90%), whereas in patients with complex PVCs survival for those with Q wave and non-Q wave infarction was 92% and 76%, respectively (p less than .001). Of those with non-Q wave infarction, only 4% of nonsurvivors were free of any PVCs, as compared with 28% of nonsurvivors in the Q wave group (p less than .02).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Prediction of late mortality after myocardial infarction from variables measured at different times during hospitalization.

The long-term prognostic importance of sets of variables from different times in the hospital course after acute myocardial infarction was examined in 818 patients discharged from the hospital. Cardiac mortality during the first year after discharge was 11.1%. For the end point death within 1 year after admission, discriminant function analysis identified 5 important factors from the history and the first 24 hours of hospitalization: maximal level of blood urea nitrogen, previous myocardial infarction, age, displaced left ventricular apex (abnormal apex) on physical examination, and sinus bradycardia (negative correlation). When data from the entire hospitalization were included, extension of infarction and maximal heart rate were also selected. When variables obtained at discharge were included, only the presence of S3 gallop and abnormal apex were selected. In subgroups of patients, neither the left ventricular ejection fraction nor the presence of complex ventricular arrhythmias during a 24-hour ambulatory monitoring were independent predictors. Correct prediction was similar for each analysis, with 55 to 60% of the deaths and 79 to 81% of survivors correctly identified. The high-risk group consisted of 25% of the patients with 28 to 30% predictive value for death in the first year. In conclusion, outcome up to 1 year after acute myocardial infarction can be predicted early after admission. Addition of more information later during the hospitalization and at discharge did not improve correct prediction and may be redundant for prognostic evaluation.

Aged↗
PubMed1984

Usefulness of the chest x-ray for predicting abnormal left ventricular function after acute myocardial infarction.

We evaluated 229 patients discharged after a definite acute myocardial infarction. Pulmonary venous congestion determined from chest x-ray films during the hospitalization and at discharge and the cardiothoracic ratio at discharge were compared to the left ventricular ejection fraction measured at discharge by a gated radionuclide technique. During hospitalization, pulmonary venous congestion was found on at least one x-ray frame in 94 patients (41%). At discharge 134 patients (59%) had abnormal ejection fraction (less than 0.51) and 35 had pulmonary venous congestion (15%). The sensitivity of the x-ray for detecting an abnormal ejection fraction was 20% when pulmonary venous congestion was observed on the discharge x-ray film (specificity 92% and predictive value 77%), 52% if pulmonary venous congestion was present on any x-ray film during the hospitalization (specificity 74% and predictive value 73%), and 47% if the cardiothoracic ratio was abnormal (greater than or equal to 0.50) on the discharge x-ray film (specificity and predictive value 66%). We conclude that an abnormal x-ray film at discharge or during the hospitalization will identify approximately one-half of the abnormal ejection fractions at the time of hospital discharge. Therefore, to reliably assess left ventricular function, either for prognostic or therapeutic purposes in the individual patient, a more direct measure of left ventricular function such as radionuclide angiography must be obtained.

Adult↗
PubMed1984

Prognostic importance of digitalis after acute myocardial infarction.

Because previous reports have suggested that digitalis administration may lead to increased mortality after hospital discharge for acute myocardial infarction, the independent importance of digitalis therapy in long-term prognosis after acute myocardial infarction was investigated by analyzing 1,599 patients after definite myocardial infarction. After hospital discharge, mortality rate for the entire group at 4 months was 7.7% and after 1 year 14.2%. At discharge, 36.6% of the patients were taking digitalis. Compared with those not taking digitalis, those taking digitalis had more historical risk factors and a higher incidence of important clinical prognostic variables during the hospitalization. Their cardiac mortality rate after 4 months and 1 year (12.5 and 22.4%, respectively) was significantly higher than that of patients not taking digitalis (5.0 and 9.6%, respectively). Mortality was higher for patients taking digitalis whether or not they had congestive heart failure during hospitalization. However, in a multivariate Cox analysis for 1 year outcome, neither digitalis nor any other medication variable displaced the important clinical variables of age, congestive heart failure during the hospitalization, previous myocardial infarction, maximal heart rate during the hospitalization and previous angina. Quinidine and digitalis at discharge were selected sixth and seventh (not significant) by the analysis. It is concluded that digitalis therapy at discharge after myocardial infarction was not an independent predictor of late mortality in these patients.

Aged↗
PubMed1983

Dynamic evaluation of prognosis from time-dependent variables in acute myocardial infarction.

For predicting the 3 endpoints death, cardiac arrest, and cardiogenic shock within 44 days after admission for acute myocardial infarction (MI), a competing risk variant of the Cox multivariate model was developed. The population consisted of 1,140 patients with definite MI admitted within 24 hours of onset of symptoms. Prognostic variables from the entire hospitalization period were assessed. The time-dependent variables (occurrence of complications) were evaluated with occurrence up through the day before the actual prediction period started. The important prognostic variables for the endpoint death were ventricular fibrillation, age, congestive heart failure, and asystole. Variables for the endpoint cardiac arrest were congestive heart failure, ventricular premature beats, supraventricular tachycardia, extension of MI, and age. Variables for the endpoint cardiogenic shock were cardiac arrest, age, congestive heart failure, previous MI, and nodal rhythm. By using a hazard function for each endpoint and the coefficients for the variables entered, it is possible to estimate a total risk of death, cardiac arrest, or cardiogenic shock for the individual patient. This prediction can be updated during the course of hospitalization according to the occurrence of the new complications. The model can be directly utilized to assess risk.

Adult↗
PubMed1983

How much prognostic information do exercise test data add to clinical data after acute myocardial infarction?

We compared the prognostic significance of variables from a symptom-limited bicycle exercise test performed three weeks after acute myocardial infarction with clinical variables from the hospitalization utilizing discriminant function analysis for one year follow-up. Clinical exclusion criteria define a high-risk group of patients not eligible for exercise testing. Among 430 patients without test 28.4% died versus 6.6% among 456 patients with test (P less than 0.0001) and 21.4% versus 9.6% experienced a new infarction (P less than 0.001). The most important exercise test variables were duration of exercise and ventricular premature beats. The prediction of death was not significantly different when clinical variables, exercise test variables or the combined set were used for positive predictive value (66.7%, 60.0%, 63.3%) and negative predictive value (71.6%, 67.4%, 71.8%). For new infarction the positive predictive value was significantly higher for exercise test variables (56.8%, P less than 0.03) or the combined set (59.3%, P less than 0.02) compared to clinical variables (45.5%). The negative predictive value was significantly higher for clinical variables (79.6%) compared to exercise data (63.6%, P less than 0.0001) or the combined set (67.0%, P less than 0.001). We conclude that exercise data cannot improve prediction of death but provides higher positive predictive value for the prediction of new infarction.

Aged↗
PubMed1983

Evaluation of prognosis one year after myocardial infarction.

Three multivariate methods for predicting death within 1 year for patients discharged after acute myocardial infarction were evaluated: Cox model, discriminant function analysis and recursive partitioning. Discriminant function analysis was utilized to predict a new myocardial infarction (any new or nonfatal infarction). A Cox classification model developed in a population of 260 patients (group 1) discharged after myocardial infarction was tested in 886 patients from the same institution (group 2) and 582 patients from another institution (group 3). Discriminant function analysis and recursive partitioning were developed in group 2 and tested in group 3. Data gathered during the entire period of hospitalization were utilized. The important variables (ordered as selected by the analyses) for the end point death were: heart failure, ventricular tachycardia and atrioventricular block in the Cox model and heart failure, previous myocardial infarction, age and ventricular premature beats in the discriminant function analysis. For the end point new myocardial infarction, the important variables were: previous myocardial infarction, heart failure, extension of infarction during the acute phase and infarct site. For predicting death and survival within 1 year, each of the three schemes was comparable. For estimating the actual risk of death, the Cox model was best. Recursive partitioning had the advantage of using only one variable--heart failure. Total correct classification ranged from 65.4 (Cox model) to 71.6% (discriminant function analysis) for the original population (groups 1 and 2) and from 47.9 (discriminant function analysis) to 54.3% (recursive partioning) when the schemes were tested in patients in group 3. The Cox model and discriminant function analysis were able to correctly predict over half of the new infarctions within 1 year.

Analysis of Variance↗
PubMed1983

Risk prediction after myocardial infarction. Comparison of three multivariate methodologies.

We predicted 30-day mortality and survival following acute myocardial infarction in two different hospital populations utilizing several multivariate statistical methodologies [linear discriminant analysis (LDA), logistic regression (LR), recursive partitioning (RP), and nearest neighbor]. Variables used were identified as predictive univariately from the base hospital and were obtained during the first 24 h after admission. LDA, LR, or RP all performed similarly within a given population; although each used the information contained in the prognostic variables differently. Application between different populations of prediction schemes based on LDA and LR was shown to be feasible but prior validation is essential.

Aged↗
PubMed1983

The length of hospitalization after acute myocardial infarction determined by risk calculation.

The feasibility of the use of a Cox model for risk assessment of individualized hospital discharge after myocardial infarction was evaluated. First, a previously developed prognostic index computed at the fifth day after admission was tested on a new population of 1140 patients. It was confirmed that after 5 days half of the patients (52%) could be discharged with low risk. Second, a new competing risk variant of the Cox model that updates prognosis according to the occurrence of complications was developed that describes the risk of death, cardiac arrest, and cardiogenic shock within 44 days after hospital admission. With a risk of one of these events being below 2% during a 14 day period after proposed discharge, 453 patients of 966 survivors (47%) could be discharged after only 5 days. A longer stay (of up to 30 days) was proposed for 338 patients (35%) to achieve the same level of risk. The savings in hospitalization days would be 15%. These results were confirmed in a new sample of 197 patients from the same institution who were discharged according to the proposed system. Of the 169 day 5 survivors, 67% were discharged on days 6 through 15 and this resulted in only two unexpected deaths and a 20% savings in hospitalization days. We conclude that individually determined discharge time is feasible without increased risk of death of severe complications after early discharge.

Age Factors↗
PubMed1981

Agreement in human interpretation of analog thallium myocardial perfusion images.

To assess the agreement of human interpretation of analog thallium myocardial perfusion images, four experienced interpreters evaluated 100 images on two occasions using a form designed to limit reader variability. A high intraobserver agreement (agreement by same observer at separate times) of 89--93% was found when films were interpreted as normal or abnormal (a dichotomous decision). Interobserver agreement for a majority grouping of observers (three or four) was 75% for an abnormal and 68% for a normal interpretation. However, agreement ranged from 11--79% when interpreters were asked to read the anatomic location of defects. Posterior and lateral wall defects were interpreted with the least amount of agreement. These results indicate that caution must be taken when interpreting defect location. Using a scale of 1--10 to grade the severity of a defect, correlations of 0.82--0.86 were found when reading defects in the lateral and anterior projections. Higher correlations, from 0.86--0.94, were found in left anterior oblique views. Use of reporting forms with specific criteria, multiple observers at one occasion, and/or computer processing may improve agreement. A brief review of the agreement of cardiology testing procedures is also presented.

Angina Pectoris↗
PubMedDate not supplied

Measuring smoking cessation: problems with recall in the 1990 California Tobacco Survey.

Measures of quitting activity are important both to evaluate public health interventions and to predict the likelihood of future quitting in the individual smoker. In population surveys, such measures are generally based on recall and thus may lack validity. In this article, we present the results of a 1-year quitting history of 8924 persons from a random-digit dialed population survey conducted in California in 1990. Respondents often forgot dates of quit attempts other than the most recent. Also, our results suggest that respondents may not recall short quit attempts at all, especially if they took place more than a few months before the interview. Thus, accurate population measures of relapse rates or quitting activity should rely on recall only for the last few months before the interview. Using data from quit attempts that took place within 4 months of the interview, actuarial analysis showed that 71.1% of attempts lasted at least 2 days, 58.5% at least 3 days, but only 39.2% lasted a week or more; this rate dropped to 19.6% at 1 month and to 14.1% at 3 months. As a predictive measure, a quit attempt that lasted a week or longer in the last year appears less biased by recall than any attempt of a day or longer in the last year.

Adolescent↗