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Biomedical subjects

William J French

Publications and source records attributed to William J French.

18 recordsLinked to original sources
PubMed2006

Rescue percutaneous coronary intervention for failed thrombolysis.

BACKGROUND: Previous studies of rescue percutaneous coronary intervention (PCI) for failed thrombolysis yielded conflicting results. In the current era of newer thrombolytic agents, coronary stents, glycoprotein IIb/IIIa inhibitors, and aggressive hemodynamic support, the outcome of this high-risk patient group has not been characterized. METHODS: From January 2000 to October 2004, 214 consecutive patients were transferred and underwent emergent coronary angiography following failed thrombolysis. One hundred and fifty five (72%) underwent immediate PCI, 23 (11%) underwent delayed PCI, and 36 (17%) received surgical revascularization or medical therapy. Medical records and angiograms for the entire PCI cohort (n=178) were reviewed for in-hospital events including bleeding complications, stroke, recurrent ischemia or myocardial infarction (MI), target vessel revascularization (TVR), and death. RESULTS: Time from symptom onset to thrombolysis (mean +/- standard deviation) was 5.6 +/- 11.9 hr, and time from thrombolysis to angiography was 7.0 +/- 5.5 hr. The study cohort was critically ill, with 9.6% experiencing cardiac arrest, 21% in cardiogenic shock, and 12% intubated prior to transfer. Coronary stents were placed in 88%, Rheolytic thrombectomy was used in 21%, an intraaortic balloon pump was placed in 17%, and a glycoprotein IIb/IIIa inhibitor was administered in 92%. Patients receiving delayed PCI had higher TIMI 3 flow grade at initial angiography than those receiving immediate PCI (83% vs. 34%, respectively, P < 0.0001). Angiographic success was 90% for the entire PCI cohort, 89% for the immediate PCI group, and 100% for the delayed PCI group. Clinical success (angiographic success and freedom from major adverse cardiac events) was 85% for the entire PCI cohort, 83% for the immediate PCI group, and 100% for the delayed PCI group. Severe and moderate bleeding complications occurred in 7.3%, stroke in 1.7%, recurrent ischemia or MI in 7.3%, and TVR in 3.4%. Overall, in-hospital mortality for the entire PCI cohort was 3.4%. CONCLUSIONS: This observational, consecutive, real-world study of contemporary rescue PCI for failed thrombolysis shows a high use of coronary stents, Rheolytic thrombectomy, glycoprotein IIb/IIIa inhibitors, and intraaortic balloon pump placement. Angiographic and clinical success was high with low bleeding complications and low in-hospital mortality, suggesting that prospective, randomized trials using contemporary interventional therapy for rescue PCI be considered.

Angioplasty, Balloon, Coronary↗
PubMed2006

Rationale for establishing regional ST-elevation myocardial infarction receiving center (SRC) networks.

Recent developments have provided a unique opportunity for the organization of regional ST-elevation myocardial infarction (STEMI) receiving center (SRC) networks. Because cumulative evidence has demonstrated that rapid primary percutaneous coronary intervention (PCI) is the most effective reperfusion strategy for acute STEMI, the development of integrated SRC networks could extend the benefits of primary PCI to a much larger segment of the US population. Factors that favor the development of regional SRC networks include results from recently published clinical trials, insight into contemporary STEMI treatment patterns from observational registries, experience with the nation's current trauma system, and technological advances. In addition, the 2004 American College of Cardiology/American Heart Association STEMI guidelines have specified that optimal "first medical contact-to-balloon" times should be <90 minutes, so a clear benchmark for timely reperfusion has been established. Achievement of this benchmark will require improvements in the current process of care as well as increased multidisciplinary cooperation between emergency medical services, emergency medicine physicians, and cardiologists. Two types of regional SRC networks have already begun to evolve in role-model cities, including prehospital cardiac triage and interhospital transfer. Regional coordination of SRC networks is needed to ensure quality monitoring and to delineate the ideal reperfusion strategy for a given community based on available resources and expertise.

Angioplasty, Balloon, Coronary↗
PubMed2006

Assessment of coronary plaque morphology by contrast-enhanced computed tomographic angiography: comparison with intravascular ultrasound.

BACKGROUND: Computed tomographic (CT) angiography provides accurate noninvasive assessment for coronary artery stenosis. The ability of CT angiography to determine plaque morphology remains unclear. METHODS: Twelve patients undergoing intravascular ultrasound for clinical indications underwent CT angiography for the evaluation of plaque morphology. Plaque morphology was classified as (1) soft, (2) fibrous, (3) fibrocalcific or (4) calcific. CT angiography data sets were evaluated for the presence and morphology of plaque in the coronary artery segments. The results were blindly compared with intravascular ultrasound results on a segment by segment basis using angiographic landmarks. RESULTS: Fifty-nine coronary segments were analyzed; 10 segments were normal and 49 contained plaque. Plaque morphology by intravascular ultrasound was soft in 12 segments, fibrous in four, fibrocalcific in 29 and calcific in four. To determine coronary segments with any plaque, CT angiography had a sensitivity of 100% (49 of 49) and specificity of 90% (9 of 10). To determine plaque morphology as calcified (fibrocalcific and calcific) versus noncalcified (soft and fibrous), CT angiography had a sensitivity of 100% (33 of 33) and a specificity of 94% (15 of 16). Overall accuracy for CT angiography to determine plaque morphology was 92% (54 of 59). CT angiography density values (Hounsfield units, mean+/-standard deviation) were significantly different for each plaque morphology: soft 23+/-71, fibrous 108+/-79, fibrocalcific 299+/-112 and calcific 404+/-264 (P<0.0001). CONCLUSIONS: CT angiography accurately characterized plaque morphology and may be a useful tool in noninvasive evaluation of plaque morphology during drug therapy trials.

Contrast Media↗
PubMed2005

Outcome in patients transferred for percutaneous coronary intervention (a national registry of myocardial infarction 2/3/4 analysis).

Hospital transfer is associated with delays in performance of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction. Given the limited number of interventional centers in the United States, the transfer of patients is widely practiced. We compared the outcome of patients who were transferred for primary PCI and determined whether prolonged door-to-balloon times were associated with increased mortality. Patients who presented within 12 hours with ST-segment elevation myocardial infarction and underwent transfer for primary PCI were identified from the National Registry of Myocardial Infarction database (NRMI databases 2, 3, and 4, n = 7,133). The short-term outcome of those who received early (< or =2 hours) was compared with that of those who received delayed primary PCI (>2 hours) using multivariate logistic regression analyses and propensity score methods. The door-to-balloon time for the early PCI group compared with the delayed PCI group was 99 +/- 16 versus 264 +/- 178 minutes, respectively (p <0.0001). The early PCI group had less recurrent ischemia and angina (5.8% vs 10.1%, p <0.001), less cardiogenic shock (5.1% vs 8.9%, p <0.001), and shorter length of hospital stay (4.4 +/- 3.5 vs 5.4 +/- 4.7 days, p <0.001). In-hospital mortality was lower for the early PCI group than for the delayed PCI group (2.7% vs 6.2%, p < 0.001; entire cohort 5.7%). Comparison of patients matched on propensity score (n = 993) showed that mortality was lower in the early than in the delayed PCI group (2.6% vs 4.6%, p = 0.014, c-statistic 0.67). In conclusion, <4% of patients who received PCI were treated within the recommended guideline of < 120 minutes by the American College of Cardiology/American Heart Association. Door-to-balloon times <2 hours in patients who undergo transfer for PCI is associated with a significant decrease in short-term mortality, which suggests that efforts must be made to decrease transfer delays.

Angioplasty, Balloon, Coronary↗
PubMed2005

Effect of statin use within the first 24 hours of admission for acute myocardial infarction on early morbidity and mortality.

We determined the effects of early statin treatment in acute myocardial infarction (AMI) on in-hospital morbidity and mortality. Experimental models of ischemia and reperfusion have shown that statins have early cardioprotective effects. However, the effect of statin use within the first 24 hours of admission on early morbidity and mortality in AMI has not been well studied. Data were collected on 300,823 patients who had AMI in the National Registry of Myocardial Infarction 4. In-hospital events were compared between patients who continued statin therapy received before the index AMI hospitalization (n = 17,118) or newly started statin therapy within the first 24 hours of hospitalization (n = 21,978) and patients who did not receive early statin treatment (n = 126,128) or whose statin therapy was discontinued (n = 9,411). New or continued treatment with a statin in the first 24 hours was associated with a decreased risk of mortality compared with no statin use (4.0% and 5.3% compared with 15.4% no statin). Discontinuation of statin treatment was associated with a slightly increased risk of mortality (16.5%). Early statin use was also associated with a lower incidence of cardiogenic shock, arrhythmias, cardiac arrest, rupture, but not recurrent myocardial infarction. Propensity analysis yielded mortality odds ratios of 0.46 for continued therapy, 0.42 for newly started therapy, and 1.25 for discontinued therapy for matched pairs versus no statin therapy (all p values <0.0001). In conclusion, the use of statin therapy within the first 24 hours of hospitalization for AMI is associated with a significantly lower rate of early complications and in-hospital mortality.

Aged↗
PubMed2005

Relationship between time of day, day of week, timeliness of reperfusion, and in-hospital mortality for patients with acute ST-segment elevation myocardial infarction.

CONTEXT: Understanding how door-to-drug and door-to-balloon times vary by time of day and day of week can inform the design of interventions to improve the timeliness of reperfusion therapy. OBJECTIVE: To determine the pattern of door-to-drug and door-to-balloon times by time of day and day of week and whether this pattern may affect mortality. DESIGN, SETTING, AND PARTICIPANTS: Cohort study of 68,439 patients with ST-segment elevation myocardial infarction (STEMI) treated with fibrinolytic therapy and 33,647 treated with percutaneous coronary intervention (PCI) from 1999 through 2002. We classified patient hospital arrival period into regular hours (weekdays, 7 am-5 pm) and off-hours (weekdays 5 pm-7 am and weekends). MAIN OUTCOME MEASURES: Geometric mean door-to-drug time for fibrinolytic therapy and door-to-balloon time for PCI and all-cause in-hospital mortality. All outcomes were adjusted for patient and hospital characteristics. RESULTS: Most fibrinolytic therapy (67.9%) and PCI patients (54.2%) were treated during off-hours. Door-to-drug times were slightly longer during off-hours (34.3 minutes) than regular hours (33.2 minutes; difference, 1.0 minute; 95% confidence interval [CI], 0.7-1.4; P<.001). In contrast, door-to-balloon times were substantially longer during off-hours (116.1 minutes) than regular hours (94.8 minutes; difference, 21.3 minutes; 95% CI, 20.5-22.2; P<.001). A lower percentage of patients met guideline recommended times for door-to-balloon during off-hours (25.7%) than regular hours (47%; P<.001). Door-to-balloon times exceeding 120 minutes occurred much more commonly during off-hours (41.5%) than regular hours (27.7%; P<.001). Longer off-hours door-to-balloon times were primarily due to a longer interval between obtaining the electrocardiogram and patient arrival at the catheterization laboratory (off-hours, 69.8 minutes vs regular hours, 49.1 minutes; P<.001). This pattern was consistent across all hospital subgroups examined. Furthermore, patients presenting during off-hours had significantly higher adjusted in-hospital mortality than patients presenting during regular hours (odds ratio, 1.07; 95% CI, 1.01-1.14; P = .02). CONCLUSIONS: Presentation during off-hours was common and was associated with substantially longer times to treatment for PCI but not for fibrinolytic therapy. To achieve the best outcomes, hospitals providing PCI during off-hours should commit to doing so in a timely manner.

Adult↗
PubMed2005

Reproducibility and variability of activated clotting time measurements in the cardiac catheterization laboratory.

The objective of this study was to characterize the reproducibility and variability in the measurement to the activated clotting time (ACT) when performed on two different types of instruments, the HemoTec ACT (Medtronic) and the Hemochron 801 (International Technidyne). The ACT has evolved into the most common point-of-care test used in the cardiac catheterization lab to manage patient heparinization. Since the test has not been standardized, different systems frequently produce different results under the same clinical conditions. Duplicate paired ACT tests (n = 885) from 359 patients were performed on both instruments. Prothrombin times (PT) and activated partial thromboplastin times (aPTT) were also determined on subsets of these same samples (PT = 533; aPTT = 487). The performance and relationships between the two tests were determined using a variety of statistical analytical techniques. The average difference between the ACT devices was only 8 sec, yet more than 60% of the measurements varied by more than 10%. Over one-fourth of measurements varied by more than 20%. The reproducibility to the HemoTec instrument was superior to the Hemochron instrument across the entire range of ACTs measured (mean coefficient of variation 2.4% +/- 3.1% vs. 7.2% +/- 6.1% for HemoTec and Hemochron, respectively; P < 0.00001; range = 65-555 sec). The relationship between the two ACTs was nonlinear. In therapeutic ranges used for interventional procedures (200-350 sec), HemoTec and Hemochron ACTs are not comparable to one another. Statistical comparative analysis indicated that the HemoTec ACT has better overall performance.

Adolescent↗
PubMed2005

Electron beam angiography for the evaluation of percutaneous atrial septal defect closure.

Electron beam angiography (EBA) provides excellent anatomic imaging in patients with congenital heart disease and may be useful in the assessment of atrial septal defects (ASDs). We present four patients with an ASD who were considered for percutaneous closure and underwent EBA for measurement of defect size and assessment of rim adequacy, adjacent cardiac structures, and associated congenital anomalies.

Adult↗
PubMed2004

Non-linear cardiac output dynamics during ramp-incremental cycle ergometry.

Published literature asserts that cardiac output (Q(.) = V(.) >O(2)x1/C((a-v))O(2)) increases as a linear function of oxygen uptake with a slope of approximately 5-6 during constant work rate exercise. However, we have previously demonstrated that C((a-v))O(2) has a linear relationship as a function of V(.)O(2) during progressively increasing work rate incremental exercise. Therefore, we hypothesized that Q(.) may indeed have a non-linear relationship with respect to V(.)O(2) during incremental, non-steady state exercise. To investigate this hypothesis, we performed five maximal progressive work rate exercise studies in healthy human subjects. Q(.) was determined every minute during exercise using measured breath-by-breath V(.) >O(2), and arterial and pulmonary artery measurements of PO(2), hemoglobin saturation, and content. Q(.) was plotted as a function of V(.) >O(2) and the linear and non-linear (first order exponential and hyperbolic) fits determined for each subject. Tests for linearity were performed by assessing the significance of the quadratic terms added to the linear relation using least squares estimation in linear regression. Linearity was inadequate in all cases (group P<0.0001). We conclude that cardiac output is a non-linear function of V(.)O(2 )during ramp-incremental exercise; the pattern of non-linearity suggests that while the kinetics of Q(.) > are faster than those of V(.) >O(2) they progressively slow as work rate (and V(.) >O(2)) increases.

Adult↗
PubMed2004

Comparability of quality-of-care indicators for emergency coronary angioplasty in patients with acute myocardial infarction regardless of on-site cardiac surgery (report from the National Registry of Myocardial Infarction).

Initial reports have suggested that primary percutaneous coronary intervention (PCI) can be performed safely in selected hospitals without on-site cardiac surgery; however, quality-of-care indicators for primary PCI in these institutions is unknown. Therefore, symptom onset-to-door intervals, door-to-balloon times, compliance with American College of Cardiology/American Heart Association (ACC/AHA) management guidelines, and in-hospital mortality were evaluated in 108,132 patients in 3 hospital settings in the National Registry of Myocardial Infarction: (1) diagnostic laboratories only (n = 47), (2) elective PCI only (n = 50), and (3) elective PCI and cardiac surgery (n = 562). Mean symptom onset-to-door intervals (127 minutes, 95% confidence interval 118 to135; 134 minutes, 95% confidence interval 125 to 142; and 140 minutes, 95% confidence intervals 138 to 141; p = 0.01) and door-to-balloon intervals (104 minutes, 95% confidence interval 101 to 108; 116 minutes, 95% confidence interval 112 to 119; and 119 minutes, 95% confidence interval 118 to 120; p <0.0001) were shorter in hospitals without cardiac surgery. Adherence to ACC/AHA guidelines for medications within the first 24 hours (aspirin, beta blockers, angiotensin-converting enzyme inhibitors) was greater in hospitals without cardiac surgery. There were comparable in-hospital mortality rates (3.2%, 4.2%, and 4.8%, respectively; p = 0.07) for patients with similar Thrombolysis In Myocardial Infarction risk scores; however, 4.7% of patients treated with primary PCI in hospitals without cardiac surgery were transferred to another institution. Thus, hospitals performing primary PCI without on-site cardiac surgery that participated in this registry have quality-of-care indicators and adherence to ACC/AHA management guidelines that are comparable to hospitals with on-site cardiac surgery. The lack of on-site cardiac surgery does not appear to adversely affect quality-of-care indicators in primary PCI.

Angioplasty, Balloon, Coronary↗
PubMed2004

Re-engineering the Los Angeles County public health care safety net: recommendations from a Blue Ribbon Health Task Force.

Public hospitals throughout the United States are under increasing fiscal and political pressure to survive because of dynamic changes in healthcare delivery, an increasing uninsured population of patients and rapidly declining reimbursement. These safety net health care programs are also saddled with outdated and bureaucratic governmental policies and procedures which make it even more difficult to improve the quality of care and efficiency of the organization. As these pressures mount, some public hospital systems have attempted to be reinvented through the re-engineering process. Los Angeles County, the second largest health system in the United States, has done relatively little to adjust to changing times. Los Angeles County Department of Health Services has been attempting to re-engineer for the past three years, but this has not averted the need for a second billion-dollar waiver in 2000 from the state and federal governments. A Blue Ribbon Health Task Force was appointed to examine the failure of re-engineering to restructure the Los Angeles public health delivery system. In this article, the group's findings and recommendations are reported. They cover three general areas: eliminating bureaucratic hurdles, improving healthcare planning and management of operations and setting priorities on critical investments in health services.

Advisory Committees↗
PubMed2003

Hormone therapy and the progression of coronary-artery atherosclerosis in postmenopausal women.

BACKGROUND: In postmenopausal women with coronary artery disease, conjugated equine estrogen with or without continuous administration of medroxyprogesterone acetate has failed to slow the progression of atherosclerosis. Whether 17beta-estradiol (the endogenous estrogen molecule) alone or administered sequentially with medroxyprogesterone acetate can slow the progression of atherosclerosis is unknown. METHODS: We conducted a double-blind, placebo-controlled trial in 226 postmenopausal women (mean age, 63.5 years) who had at least one coronary-artery lesion. Participants were randomly assigned to usual care (control group), estrogen therapy with micronized 17beta-estradiol alone (estrogen group), or 17beta-estradiol plus sequentially administered medroxyprogesterone acetate (estrogen-progestin group). In all patients the low-density lipoprotein (LDL) cholesterol level was reduced to a target of less than 130 mg per deciliter. The primary outcome was the average per-participant change between base-line and follow-up coronary angiograms in the percent stenosis measured by quantitative coronary angiography. RESULTS: After a median of 3.3 years of follow-up, the mean (+/-SE) change in the percent stenosis in the 169 participants who had a pair of matched angiograms was 1.89+/-0.78 percentage points in the control group, 2.18+/-0.76 in the estrogen group, and 1.24+/-0.80 in the estrogen-progestin group (P=0.66 for the comparison among the three groups). The mean difference in the percent stenosis between the estrogen group and the control group was 0.29 percentage point (95 percent confidence interval, -1.88 to 2.46), and the mean difference between the estrogen-progestin group and the control group was -0.65 (95 percent confidence interval, -2.87 to 1.57). CONCLUSIONS: In older postmenopausal women with established coronary-artery atherosclerosis, 17beta-estradiol either alone or with sequentially administered medroxyprogesterone acetate had no significant effect on the progression of atherosclerosis.

Coronary Angiography↗
PubMed2002

The association of sex and payer status on management and subsequent survival in acute myocardial infarction.

BACKGROUND: Previous reports have generally shown lower utilization of hospital resources and lower survival in women than men with acute myocardial infarction. However, to our knowledge, no reports have described the influence of payer status on the treatment and outcome of women and men with acute myocardial infarction. METHODS: Baseline and clinical presenting characteristics, utilization of hospital resources, and subsequent clinical outcome were ascertained among 327 040 women and men enrolled in a national registry of myocardial infarction from June 1, 1994, to January 31, 1997. Separate Cox regression analyses were performed for Medicare, Medicaid, health maintenance organizations, and commercial payer groups to ascertain variables that were predictive of mortality in the study population. RESULTS: After adjustment for differences in age and other baseline and presenting characteristics, women were significantly more likely than men to die in the hospital (hazard ratio, 1.13; 95% confidence interval, 1.10-1.16), and this difference was greatest among women with health maintenance organization and commercial insurance (hazard ratios, 1.30 and 1.29, respectively), and least among women with Medicare (hazard ratio, 1.07). However, after adjustment for the additional effect on short-term survival of sex differences in the utilization of both pharmacologic treatments administered within the first 24 hours and invasive cardiac procedures, the mortality difference observed for women and men further diminished (hazard ratio, 1.08; 95% confidence interval, 1.05-1.10). CONCLUSION: In this large registry, we did not observe significant variations among payer classes in management and mortality among women and men after acute myocardial infarction.

Aged↗
PubMed2002

Primary angioplasty and selection bias inpatients presenting late (>12 h) after onset of chest pain and ST elevation myocardial infarction.

OBJECTIVES: This study was designed to compare the in-hospital outcome of patients presenting with >12 h from onset of chest pain and acute ST elevation myocardial infarction (AMI) who received either immediate invasive or conservative therapy. BACKGROUND: The benefits of fibrinolytic therapy diminish in patients presenting with AMI and onset of chest pain >12 h. Primary angioplasty has been suggested as a possible treatment for such patients, but they have been excluded from most trials of primary angioplasty. It remains unclear if an invasive treatment strategy is beneficial to these patients. METHODS: Patients presenting with >12 h of chest pain and AMI were identified from the National Registry of Myocardial Infarction 2 database. Patients receiving invasive therapy <6 h after hospital admission were compared with those receiving conservative therapy. Short-term outcomes were compared on the basis of the initial therapy received. To help control for baseline differences in the groups, patients were matched with controls by propensity score methodology. RESULTS: On preliminary analysis, in-hospital outcome was improved in terms of recurrent ischemia, angina, myocardial infarction and mortality in patients receiving initial invasive therapy (odds ratio [OR] = 0.67; 95% confidence interval [CI] 0.49 to 0.92 for mortality). After matching by propensity score, the mortality benefit persisted on bivariate analysis (3.5% vs. 5.0%, p = 0.036), though on multivariate analysis, only a non-significant but strong trend toward decreased mortality remained (OR = 0.73; 95% CI 0.53 to 1.01). CONCLUSIONS: Patients receiving early invasive therapy had lower risk features on presentation. Selection bias may play an important role in choosing these patients' course of treatment and their subsequent outcomes. Certain patients presenting with AMI and duration of chest pain >12 h may benefit from early invasive therapy. These patients could be characterized in a randomized trial.

Aged↗
PubMed2002

Is there a benefit to early angiography in patients with ST-segment depression myocardial infarction? An observational study.

BACKGROUND AND OBJECTIVE: Patients with ST-segment depression myocardial infarction (MI) have a similar long-term outcome compared with those who have ST-segment elevation. It remains unclear whether an aggressive treatment approach with very early (<6 hours) angiography and revascularization improves outcome over an early conservative approach. We compared the short-term outcome of patients who received very early (<6 hours) angiography with patients who received early conservative therapy for ST-segment depression MI. METHODS: Patients seen within 12 hours with ST-segment depression on the initial electrocardiogram (ECG) were identified from the National Registry of Myocardial Infarction 2 (NRMI) database, which collected information from 1994 to 1998. Those who received very early (<6 hours) angiography were compared with those who received early conservative therapy. The short-term outcomes, including major bleeding episodes, cerebral vascular events, recurrent ischemia and angina, MI, and death, were compared on the basis of the initial therapy received. RESULTS: Patients treated with very early angiography (2402) were younger, more likely to be males, smokers, and have less of a cardiac history (angina, MI, congestive heart failure, aortocoronary bypass surgery) and less likely to have diabetes mellitus than those who received early conservative therapy (17,735). Hospital outcome in the very early angiography group was similar to the early conservative therapy group in terms of cerebral vascular events (0.8% vs 1.0%, P =.27), major bleeding events (2.8% vs 2.4%, P =.25), and recurrent MI (2.1% vs 2.3%, P =.57) but was associated with lower recurrent ischemia or angina (11.4% vs 16.7%, P <.001) and improved survival (death, 4.9% vs 7.3%, P <.001). Multivariate analysis suggested that patients receiving very early angiography had lower mortality compared with those receiving early conservative therapy (odds ratio [OR] = 0.76; 95% CI 0.60-0.95). However, comparing patients matched on propensity score (1405) showed mortality was similar in both treatment groups (5.6% vs 5.4%, P =.87), with no significant inhospital mortality benefit of very early angiography (OR = 0.89; 95% CI 0.71-1.13). CONCLUSIONS: The apparent mortality benefit of very early angiography in patients with ST-segment depression MI is a reflection of bias by confounding. Controlling for baseline differences using propensity score methods in this observational study indicated no inhospital mortality benefit of a very early aggressive approach compared with a conservative approach.

Age Factors↗
PubMed2002

Electron beam tomography and angiography: sex differences.

BACKGROUND: We sought to study a large cohort of symptomatic women to determine the clinical use of electron beam tomography (EBT), with evaluation of the sensitivity and specificity of obstructive coronary disease and the differences between premenopausal and postmenopausal cohorts. METHODS: Patients who underwent angiography for evaluation of coronary artery disease (CAD) and EBT within 3 months were enrolled. Receiver operating characteristic curves were used to establish relationships between EBT calcium scores and angiographic disease. RESULTS: We studied 1120 symptomatic patients, 387 women and 733 men. We found no significant differences with respect to sensitivity for obstructive disease (96% in men and women). However, women had a significantly higher specificity (46% in men versus 57% in women; P =.01). The area under the curves for coronary calcium score predicting angiographic disease was 0.85 for all patients and 0.84 in women. Evaluation of scores on the basis of age revealed a 14.4-year lag between men and women. One hundred thirty-five women had negative EBT study results (score, zero; no calcium present), with 6 with single-vessel disease and 129 with normal coronaries or nonobstructive disease only (negative predictive value, 96%). CONCLUSION: EBT may have a great value in evaluation of women with possible CAD. The high sensitivity and high negative predictive value may serve as the basis for a new diagnostic approach to filter symptomatic women with suspected CAD before coronary angiography.

Calcinosis↗