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Sample records for infarction risk score

  1. The predictive value of CHADS? risk score in post myocardial infarction arrhythmias - a Cardiac Arrhythmias and RIsk Stratification after Myocardial infArction (CARISMA) substudy

    DEFF Research Database (Denmark)

    Ruwald, Anne Christine; Gang, Uffe

    2014-01-01

    BACKGROUND: Previous studies have shown substantially increased risk of cardiac arrhythmias and sudden cardiac death in post-myocardial infarction (MI) patients. However it remains difficult to identify the patients who are at highest risk of arrhythmias in the post-MI setting. The purpose of this study was to investigate if CHADS? score (congestive heart failure, hypertension, age ?75 years, diabetes and previous stroke/TCI [doubled]) can be used as a risk tool for predicting cardiac arrhythmias after MI. METHODS: The study included 297 post-MI patients from the CARISMA study with left ventricular ejection fraction (LVEF) ?40%. All patients were implanted with an implantable cardiac monitor (ICM) within 5 to 21 days post-MI and followed every three months for two years. Atrial fibrillation, bradyarrhythmias and ventricular tachycardias were diagnosed using the ICM, pacemaker or ICD. Patients were stratified according to CHADS? score at enrollment. Congestive heart failure was defined as LVEF ?40% and NYHA class II, III or IV. RESULTS: We found significantly increased risk of an arrhythmic event with increasing CHADS? score (CHADS? score=1-2: HR=2.1 [1.1-3.9], p=0.021, CHADS? score ? 3: HR=3.7 [1.9-7.1], p<0.001). This pattern was identical when dividing the arrhythmias into subgroups of atrial fibrillation, ventricular tachycardias and bradyarrhythmias. CHADS? score was similarly associated with the development of major cardiovascular events defined as reinfarction, stroke, and hospitalization for heart failure or cardiovascular death. CONCLUSION: In the post-MI setting, CHADS? score efficiently identifies populations at high risk for cardiac arrhythmias.

  2. A genetic risk score of 45 coronary artery disease risk variants associates with increased risk of myocardial infarction in 6041 Danish individuals

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    Krarup, N T; Borglykke, A

    2015-01-01

    BACKGROUND: In Europeans, 45 genetic risk variants for coronary artery disease (CAD) have been identified in genome-wide association studies. We constructed a genetic risk score (GRS) of these variants to estimate the effect on incidence and clinical predictability of myocardial infarction (MI) and CAD. METHODS: Genotype was available from 6041 Danes. An unweighted GRS was constructed by making a summated score of the 45 known genetic CAD risk variants. Registries provided information (mean follow-up = 11.6 years) on CAD (n = 374) and MI (n = 124) events. Cox proportional hazard estimates with age as time scale was adjusted for sex, BMI, type 2 diabetes mellitus and smoking status. Analyses were also stratified either by sex or median age (below or above 45 years of age). We estimated GRS contribution to MI prediction by assessing net reclassification index (NRI) and integrated discrimination improvement (IDI) added to the European SCORE for 10-year MI risk prediction. RESULTS: The GRS associated significantly with risk of incident MI (allele-dependent hazard ratio (95%CI): 1.06 (1.02-1.11), p = 0.01) but not with CAD (p = 0.39). Stratification revealed association of GRS with MI in men (1.06 (1.01-1.12), p = 0.02) and in individuals above the median of 45.11 years of age (1.06 (1.00-1.12), p = 0.03). There was no interaction between GRS and gender (p = 0.90) or age (p = 0.83). The GRS improved neither NRI nor IDI. CONCLUSION: The GRS of 45 GWAS identified risk variants increase the risk of MI in a Danish cohort. The GRS did not improve NRI or IDI beyond the performance of conventional European SCORE risk factors.

  3. Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: nationwide propensity score matched study

    DEFF Research Database (Denmark)

    Charlot, Mette; Grove, Erik

    2011-01-01

    OBJECTIVE: To examine the effect of proton pump inhibitors on adverse cardiovascular events in aspirin treated patients with first time myocardial infarction. DESIGN: Retrospective nationwide propensity score matched study based on administrative data. Setting All hospitals in Denmark. PARTICIPANTS: All aspirin treated patients surviving 30 days after a first myocardial infarction from 1997 to 2006, with follow-up for one year. Patients treated with clopidogrel were excluded. MAIN OUTCOME MEASURES: The risk of the combined end point of cardiovascular death, myocardial infarction, or stroke associated with use of proton pump inhibitors was analysed using Kaplan-Meier analysis, Cox proportional hazard models, and propensity score matched Cox proportional hazard models. Results 3366 of 19,925 (16.9%) aspirin treated patients experienced recurrent myocardial infarction, stroke, or cardiovascular death. The hazard ratio for the combined end point in patients receiving proton pump inhibitors based on the time dependent Cox proportional hazard model was 1.46 (1.33 to 1.61; P<0.001) and for the propensity score matched model based on 8318 patients it was 1.61 (1.45 to 1.79; P<0.001). A sensitivity analysis showed no increase in risk related to use of H(2) receptor blockers (1.04, 0.79 to 1.38; P=0.78). Conclusion In aspirin treated patients with first time myocardial infarction, treatment with proton pump inhibitors was associated with an increased risk of adverse cardiovascular events.

  4. Validation of grace risk score in predicting in-hospital mortality in patients with non ST-elevation myocardial infarction and unstable angina

    International Nuclear Information System (INIS)

    Objective: To validate the global registry of acute coronary event (grace) risk score in a Pakistani population at Tabba Heart Institute Karachi in patients with non ST-Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA). Methods: In this prospective Observational registry study, 530 adults hospitalized patients with a diagnosis of Non-ST-Elevation Myocardial Infarction and unstable angina were enrolled between March 2012 and August 2012 at the Tabba Heart Institute, Karachi, Pakistan. For each patient, the grace risk score was calculated and its discrimination evaluated and correlated with in-hospital mortality using the Kendall's tau-b bivariate correlation test. Each patient was grouped either into high, intermediate or low risk groups according to their GRS. Results: A total of 530 patients with NSTEMI and UA were included; the overall mean grace risk score in our population wa+-41.56. The GRACE Risk Score showed good discrimination, with Area under the ROC curve of 0.803 (95% CI 0.705-0.902, P < 0.001). During the in-hospital stay, total of 19 (3.6%) patients died, and out of those 15 (8.4%) patients belonged to high risk group. Conclusion: GRACE RS strongly validates the in-hospital mortality among our patient population presenting with a wide spectrum of complications. However, more multicentre registries on a larger population with long term follow up are required to study detailed trends in our population. (author)

  5. Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction : nationwide propensity score matched study

    DEFF Research Database (Denmark)

    Charlot, Mette Gitz; Grove, Erik L

    2011-01-01

    OBJECTIVE: To examine the effect of proton pump inhibitors on adverse cardiovascular events in aspirin treated patients with first time myocardial infarction. DESIGN: Retrospective nationwide propensity score matched study based on administrative data. Setting All hospitals in Denmark. PARTICIPANTS: All aspirin treated patients surviving 30 days after a first myocardial infarction from 1997 to 2006, with follow-up for one year. Patients treated with clopidogrel were excluded. MAIN OUTCOME MEASURES: The risk of the combined end point of cardiovascular death, myocardial infarction, or stroke associated with use of proton pump inhibitors was analysed using Kaplan-Meier analysis, Cox proportional hazard models, and propensity score matched Cox proportional hazard models. Results 3366 of 19,925 (16.9%) aspirin treated patients experienced recurrent myocardial infarction, stroke, or cardiovascular death. The hazard ratio for the combined end point in patients receiving proton pump inhibitors based on the time dependent Cox proportional hazard model was 1.46 (1.33 to 1.61; P

  6. Coronary artery calcium scoring in myocardial infarction

    International Nuclear Information System (INIS)

    Background. The aim of this study was to evaluate coronary artery calcium scoring and the assessment of the risk factors in patients with myocardial infarction (MI). Methods. During the period of three years, 27 patients with MI were analyzed. The average age of patients was 66.1 years (46 to 81). Coronary arteries calcium was evaluated by multi row detector computed tomography (MTDC) Somatom Volume Zoom Siemens, and, retrospectively by ECG gating data acquisition. Semi automated calcium quantification to calculate Agatston calcium score (CS) was performed with 4 x 2.5 mm collimation, using 130 ml of contrast medium, injected with an automatic injector, with the flow rate of 4 ml/sec. The delay time was determined empirically. At the same time several risk factors were evaluated. Results. Out of 27 patients with MI, 3 (11.1%) patients had low CS (10- 100), 5 (18.5%) moderate CS (101- 499), and 19 (70.4%) patients high CS (>500). Of risk factors, smoking was confirmed in 17 (63.0%), high blood pressure (HTA) in 10 (57.0%), diabetes mellitus in 7 (25.9%), positive family history in 5 (18.5%), pathological lipids in 5 (18.5%), alcohol abuse in 4 (1.8%) patients. Six (22.2%) patients had symptoms of angina pectoris. Conclusions. The research showed high correlation of MI and high CS (>500). Smoking, HTA, diabetes mellitus, positive family history and hypercholesterolemia are significant risk factors. Symptoms are relatively poor in large number of pa are relatively poor in large number of patients. (author)

  7. Comparison of Selvester QRS score with magnetic resonance imaging measured infarct size in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Carlsen, Esben A; Bang, Lia E

    2012-01-01

    Recent studies have shown that the Selvester QRS score is significantly correlated with delayed enhancement-magnetic resonance imaging (DE-MRI) measured myocardial infarct (MI) size in reperfused ST elevation MI (STEMI). This study further tests the hypothesis that Selvester QRS score correlates well with MI size determined by DE-MRI in reperfused STEMI.

  8. Addition of brain infarction to the ABCD2 Score (ABCD2I): a collaborative analysis of unpublished data on 4574 patients.

    OpenAIRE

    Giles, MF; Albers, GW; Amarenco, P; Arsava, MM; Asimos, A; Ay, H; Calvet, D.; Coutts, S; Cucchiara, BL; Demchuk, AM; Johnston, SC; Kelly, PJ (Paul); Kim, AS; Labreuche, J; Lavallee, PC

    2010-01-01

    BACKGROUND AND PURPOSE: The ABCD system was developed to predict early stroke risk after transient ischemic attack. Incorporation of brain imaging findings has been suggested, but reports have used inconsistent methods and been underpowered. We therefore performed an international, multicenter collaborative study of the prognostic performance of the ABCD(2) score and brain infarction on imaging to determine the optimal weighting of infarction in the score (ABCD(2)I). METHODS: Twelve centers p...

  9. Cardiac risk stratification: Role of the coronary calcium score

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    Rakesh K Sharma

    2010-07-01

    Full Text Available Rakesh K Sharma1, Rajiv K Sharma1, Donald J Voelker1, Vibhuti N Singh2, Deepak Pahuja3, Teresa Nash1, Hanumanth K Reddy11Medical Center of South Arkansas, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2Bayfront Medical Center, St Petersburg, Florida; 3Saint Vincent Health Center, Erie, PA, USAAbstract: Coronary artery calcium (CAC is an integral part of atherosclerotic coronary heart disease (CHD. CHD is the leading cause of death in industrialized nations and there is a constant effort to develop preventative strategies. The emphasis is on risk stratification and primary risk prevention in asymptomatic patients to decrease cardiovascular mortality and morbidity. The Framingham Risk Score predicts CHD events only moderately well where family history is not included as a risk factor. There has been an exploration for new tests for better risk stratification and risk factor modification. While the Framingham Risk Score, European Systematic Coronary Risk Evaluation Project, and European Prospective Cardiovascular Munster study remain excellent tools for risk factor modification, the CAC score may have additional benefit in risk assessment. There have been several studies supporting the role of CAC score for prediction of myocardial infarction and cardiovascular mortality. It has been shown to have great scope in risk stratification of asymptomatic patients in the emergency room. Additionally, it may help in assessment of progression or regression of coronary artery disease. Furthermore, the CAC score may help differentiate ischemic from nonischemic cardiomyopathy.Keywords: coronary calcium scoring, coronary artery disease, CAC, cardiomyopathy, angiography, chest pain, Framingham, risk stratification, risk factors

  10. Plasma HDL cholesterol and risk of myocardial infarction : a mendelian randomisation study

    DEFF Research Database (Denmark)

    Voight, Benjamin F; Peloso, Gina M

    2012-01-01

    BACKGROUND: High plasma HDL cholesterol is associated with reduced risk of myocardial infarction, but whether this association is causal is unclear. Exploiting the fact that genotypes are randomly assigned at meiosis, are independent of non-genetic confounding, and are unmodified by disease processes, mendelian randomisation can be used to test the hypothesis that the association of a plasma biomarker with disease is causal. METHODS: We performed two mendelian randomisation analyses. First, we used as an instrument a single nucleotide polymorphism (SNP) in the endothelial lipase gene (LIPG Asn396Ser) and tested this SNP in 20 studies (20?913 myocardial infarction cases, 95?407 controls). Second, we used as an instrument a genetic score consisting of 14 common SNPs that exclusively associate with HDL cholesterol and tested this score in up to 12?482 cases of myocardial infarction and 41?331 controls. As a positive control, we also tested a genetic score of 13 common SNPs exclusively associated with LDL cholesterol. FINDINGS: Carriers of the LIPG 396Ser allele (2·6% frequency) had higher HDL cholesterol (0·14 mmol/L higher, p=8×10(-13)) but similar levels of other lipid and non-lipid risk factors for myocardial infarction compared with non-carriers. This difference in HDL cholesterol is expected to decrease risk of myocardial infarction by 13% (odds ratio [OR] 0·87, 95% CI 0·84-0·91). However, we noted that the 396Ser allele was not associated with risk of myocardial infarction (OR 0·99, 95% CI 0·88-1·11, p=0·85). From observational epidemiology, an increase of 1 SD in HDL cholesterol was associated with reduced risk of myocardial infarction (OR 0·62, 95% CI 0·58-0·66). However, a 1 SD increase in HDL cholesterol due to genetic score was not associated with risk of myocardial infarction (OR 0·93, 95% CI 0·68-1·26, p=0·63). For LDL cholesterol, the estimate from observational epidemiology (a 1 SD increase in LDL cholesterol associated with OR 1·54, 95% CI 1·45-1·63) was concordant with that from genetic score (OR 2·13, 95% CI 1·69-2·69, p=2×10(-10)). INTERPRETATION: Some genetic mechanisms that raise plasma HDL cholesterol do not seem to lower risk of myocardial infarction. These data challenge the concept that raising of plasma HDL cholesterol will uniformly translate into reductions in risk of myocardial infarction. FUNDING: US National Institutes of Health, The Wellcome Trust, European Union, British Heart Foundation, and the German Federal Ministry of Education and Research.

  11. Difference in MRI findings and risk factors between multiple infarction without dementia and multi-infarct dementia

    International Nuclear Information System (INIS)

    MRI findings and risk factors for vascular dementia were evaluated with multi-variate analysis in 96 multi-infarct patients without dementia and 40 multi-infarct patients with dementia (MID). Only subjects with small infarcts in the territory of the perforator artery or deep white matter were studied. The diagnosis of MID was diagnosed according to DMS-III criteria and Hachinski's ischemia score. Location and area of patchy high-intensity areas including small infarcts, the degree of periventricular high intensity (PVH), and the degree of brain atrophy were examined with MR images. Independent variables were: history of hypertension, diabetes mellitus, other complications; systolic and diastolic blood pressure, atherosclerotic index, hematocrit, history of smoking, level of education, and activities of daily life (ADL). Hayashi's quantification method II was used to analyze the data. The most significant correlation was found between history of hypertension and dementia (partial correlation coefficient: 0.39). Significant correlations were also found between ADL and dementia (0.32), between thalamic infarction and dementia (0.31), and between PVH and dementia (0.27). Age, brain atrophy index, and history of diabetes mellitus contributed little to dementia. The contribution to dementia did not differ significantly between right and left patchy high-intensity areas on MR images. Location of infarcts, except for bilateral thalamic infarcts and large PVH, contributed littc infarcts and large PVH, contributed little to dementia. Thus it would be difficult to base a prediction of the prevalence of vascular dementia on MRI findings. However, both hypertention and ADL contribute to vascular dementia and both are treatable, which may be significant for the prevention of dementia. (author)

  12. Comparison of infarct size changes with delayed contrast-enhanced magnetic resonance imaging and electrocardiogram QRS scoring during the 6 months after acutely reperfused myocardial infarction

    DEFF Research Database (Denmark)

    Bang, L.E.; Ripa, R.S.

    2008-01-01

    INTRODUCTION: Magnetic resonance imaging using the delayed contrast-enhanced (DE-MRI) method can be used for characterizing and quantifying myocardial infarction (MI). Electrocardiogram (ECG) score after the acute phase of MI can be used to estimate the portion of left ventricular myocardium that has infarcted. There are no comparison of serial changes on ECG and DE-MRI measuring infarct size. AIM: The general aim of this study was to describe the acute, healing, and chronic phases of the changes in infarct size estimated by the ECG and DE-MRI. The specific aim was to compare estimates of the Selvester QRS scoring system and DE-MRI to identify the difference between the extent of left ventricle occupied by infarction in the acute and chronic phases. METHODS: In 31 patients (26 men, age 56 +/- 9) with reperfused ST-elevation MI (11 anterior, 20 inferior), standard 12-lead ECG and DE-MRI were taken from 1 to 2 days (acute), 1 month (healing), and 6 months (chronic) after the MI. Selvester QRS scoring was used to estimate the infarct size from the ECG. RESULTS: The correlation values between infarct size measured by DE-MRI and QRS scoring range from 0.33 to 0.43 higher for anterior than inferior infarcts. The infarct size estimated by QRS scoring was larger (about 5% of the left ventricle) than infarct size by DE-MRI acute and 1 month, but at 6 months, there was no difference. In about half of the patients, the QRS score agreed with DE-MRI in change of infarct size from acute to 6 months. CONCLUSION: In conclusion, the Selvester QRS scoring system is in half of the patients with reperfused first time MI in good accordance with DE-MRI in identifying a decrease or no change in the extent of left ventricle occupied by infarction in the acute and chronic phases Udgivelsesdato: 2008/11

  13. Comparative characteristics of diabetes risk scores

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    Svetlana Vladimirovna Mustafina

    2014-06-01

    Full Text Available The worldwide prevalence of diabetes among adults (aged 20–79 years was 8.35% in 2013, and this is expected to increase by 55% (592 million adults by 2035. To avoid the increase in the prevalence of diabetes, primary prevention and early diagnosis of prediabetes are required. It is important to identify individuals at a high risk of hyperglycaemia using inexpensive and available methods. At present, risk score is an alternative to identify the risk of developing diabetes. There are approximately 10 types of risk scores in the world, and further research for the development and adaptation of risk scores for various populations are being conducted. The use of risk score methods for prediction allows the setting of the level of total risk, identification of high-risk patients and prescription of necessary preventive measures. Actual validation of existing diabetes risk score for the Russian population is being conducted. Assessment of the risk of diabetes is simple, fast, inexpensive, non-invasive and reliable.

  14. Irregularly shaped lacunar infarction: risk factors and clinical significance / Infartos lacunares com morfologia irregular: fatores de risco e significado clinico

    Scientific Electronic Library Online (English)

    Chao, Feng; Yu, Xu; Ting, Hua; Xue-Yuan, Liu; Min, Fang.

    2013-10-01

    Full Text Available Objetivo Estudar as diferentes formas dos infartos lacunares agudos, investigando os fatores de risco e o significado clinico daqueles com morfologia irregular. Métodos Os 204 pacientes com infartos lacunares agudos foram classificados em dois grupos: aqueles com morfologia regular e aqueles com [...] morfologia irregular. Foram estudadas as características dos dois grupos e caracterizados os fatores de risco para infartos irregulares, deterioração neurológica e altos escores da escala de Rankin modificada. Resultados Variabilidade da pressão arterial é fator de risco independente para infartos lacunares irregulares. Tamanho do infarto, prevalência de leucoaraiose e formato irregular dos infartos lacunares são fatores de risco independentes para escores mais elevados na escala de Rankin modificada. Conclusões Variabilidade da pressão arterial está relacionada ao formato irregular dos infartos lacunares agudos. Este tipo de infarto e a leucoaraiose podem estar relacionado a desfechos clínicos desfavoráveis. Abstract in english Objective Our study focused on acute lacunar infarct shapes to explore the risk factors and clinical significance of irregularly shaped lacunar infarctions. Methods Based on the shape of their acute lacunar infarct, patients (n=204) were classified into the “regular” group or “irregular” group. T [...] he characteristics of the lacunar infarction were compared between the regular and irregular groups, between patients with and without neurological deterioration, and between patients with different modified Rankin scale (mRS) scores. The risk factors for irregularly shaped lacunar infarctions, neurological deterioration, and high mRS scores were identified. Results Blood pressure variability (BPV) was an independent risk factor for irregularly shaped lacunar infarction. Infarction size, prevalence of advanced leukoaraiosis, and irregularly shaped lacunar infarcts were independent risk factors for higher mRS scores. Conclusions The irregularly shaped lacunar infarcts were correlated with BPV. Irregularly shaped lacunar infarctions and leukoaraiosis may be associated with unfavorable clinical outcomes.

  15. Distribution of brain infarction in children with tuberculous meningitis and correlation with outcome score at 6 months

    International Nuclear Information System (INIS)

    Prognostic indicators for tuberculous meningitis (TBM) offer realistic expectations for parents of affected children. Infarctions affecting the basal ganglia are associated with a poor outcome. To correlate the distribution of infarction in children with TBM on CT with an outcome score (OS). CT brain scans in children with TBM were retrospectively reviewed and the distribution of infarctions recorded. The degree of correlation with OS at 6 months was determined. There was a statistically significant association between all sites of infarction (P = 0.0001-0.001), other than hemispheric (P = 0.35), and outcome score. There was also a statistically significant association between all types of infarction (P = 0.0001-0.02), other than hemispheric (P = 0.05), and overall poor outcome. The odds ratio for poor outcome with bilateral basal ganglia and internal capsule infarction was 12. The odds ratio for poor outcome with 'any infarction' was 4.91 (CI 2.24-10.74), with 'bilateral infarctions' 8.50 (CI 2.49-28.59), with basal ganglia infarction 5.73 (CI 2.60-12.64), and for hemispheric infarction 2.30 (CI 1.00-5.28). Infarction is associated with a poor outcome unless purely hemispheric. MRI diffusion-weighted imaging was not part of this study, but is likely to play a central role in detecting infarctions not demonstrated by CT. (orig.)

  16. Distribution of brain infarction in children with tuberculous meningitis and correlation with outcome score at 6 months

    Energy Technology Data Exchange (ETDEWEB)

    Andronikou, Savvas [University of Stellenbosch, Department of Radiology, Tygerberg Hospital, P.O. Box 19063, Tygerberg (South Africa); Wilmshurst, Jo; Hatherill, Mark [University of Cape Town, Pediatric Neurology, Red Cross Children' s Hospital, School of Child and Adolescent Health, Cape Town (South Africa); VanToorn, Ronald [University of Stellenbosch, Department of Pediatric Neurology, Tygerberg Hospital, Cape Town (South Africa)

    2006-12-15

    Prognostic indicators for tuberculous meningitis (TBM) offer realistic expectations for parents of affected children. Infarctions affecting the basal ganglia are associated with a poor outcome. To correlate the distribution of infarction in children with TBM on CT with an outcome score (OS). CT brain scans in children with TBM were retrospectively reviewed and the distribution of infarctions recorded. The degree of correlation with OS at 6 months was determined. There was a statistically significant association between all sites of infarction (P = 0.0001-0.001), other than hemispheric (P = 0.35), and outcome score. There was also a statistically significant association between all types of infarction (P = 0.0001-0.02), other than hemispheric (P = 0.05), and overall poor outcome. The odds ratio for poor outcome with bilateral basal ganglia and internal capsule infarction was 12. The odds ratio for poor outcome with 'any infarction' was 4.91 (CI 2.24-10.74), with 'bilateral infarctions' 8.50 (CI 2.49-28.59), with basal ganglia infarction 5.73 (CI 2.60-12.64), and for hemispheric infarction 2.30 (CI 1.00-5.28). Infarction is associated with a poor outcome unless purely hemispheric. MRI diffusion-weighted imaging was not part of this study, but is likely to play a central role in detecting infarctions not demonstrated by CT. (orig.)

  17. A new scoring system to stratify risk in unstable angina

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    Salzberg Simón

    2003-08-01

    Full Text Available Abstract Background We performed this study to develop a new scoring system to stratify different levels of risk in patients admitted to hospital with a diagnosis of unstable angina (UA, which is a complex syndrome that encompasses different outcomes. Many prognostic variables have been described but few efforts have been made to group them in order to enhance their individual predictive power. Methods In a first phase, 473 patients were prospectively analyzed to determine which factors were significantly associated with the in-hospital occurrence of refractory ischemia, acute myocardial infarction (AMI or death. A risk score ranging from 0 to 10 points was developed using a multivariate analysis. In a second phase, such score was validated in a new sample of 242 patients and it was finally applied to the entire population (n = 715. Results ST-segment deviation on the electrocardiogram, age ? 70 years, previous bypass surgery and troponin T ? 0.1 ng/mL were found as independent prognostic variables. A clear distinction was shown among categories of low, intermediate and high risk, defined according to the risk score. The incidence of the triple end-point was 6 %, 19.2 % and 44.7 % respectively, and the figures for AMI or death were 2 %, 11.4 % and 27.6 % respectively (p Conclusions This new scoring system is simple and easy to achieve. It allows a very good stratification of risk in patients having a clinical diagnosis of UA. They may be divided in three categories, which could be of help in the decision-making process.

  18. Gender and secondary risk assessment following an ST-elevation myocardial infarction

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    Scruth E

    2013-08-01

    Full Text Available Elizabeth Scruth,1,3 Linda Worrall-Carter,1 Eugene Cheng2 1St Vincent’s/ACU Centre for Nursing Research, School of Nursing and Midwifery, Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia; 2Kaiser Permanente Medical Group, San Jose, CA, USA; 3Kaiser Permanente Northern California, Oakland, CA, USA Purpose: The Thrombolysis in Myocardial Infarction (TIMI risk score, Global Register of Acute Coronary Events (GRACE risk score, and the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC risk score are validated predictors of secondary events and death after an acute coronary syndrome (ACS. In our study, we sought to examine the predictability of the TIMI, GRACE, and the CADILLAC risk scores in women undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI for in-hospital, 1-year major cardiac events, nonmajor cardiac events, and mortality. A limited number of studies examining the secondary risk scores for use after STEMI in women have been conducted. Most studies have been conducted in both men and women without separating out the predictability in women in regard to the various risk scores. Patients and methods: In a subanalysis of women from a larger study of both men and women with STEMI, a 1-year follow up of 77 women with STEMI was undertaken using a retrospective approach and comparing the TIMI, GRACE, and CADILLAC risk scores for in-hospital and 1-year outcomes of major cardiac events, nonmajor cardiac events, and death. The predictive value of the models was assessed with evaluation of the area under the curve in receiver operating-characteristic analysis. Results: The study revealed that risk stratification of female patients with STEMI early after presentation using the TIMI risk score or after angiography using the CADILLAC risk score may provide important prognostic information and enable accurate identification of high-risk patients. Conclusion: Though limited by sample size and retrospective analysis, our study provided evidence into the validity of using existing secondary risk tools in women. Further studies are needed to determine the risk score that is most predictive for women presenting with STEMI and treated with percutaneous coronary intervention. It may be useful to incorporate the risk scores into clinical practice to guide short- and long-term follow-up after STEMI in women as a preventive strategy. Keywords: cardiovascular risk, acute coronary syndromes, nonmajor cardiac events, major cardiac events

  19. Prognostic value of the age, creatinine, and ejection fraction score for 1-year mortality in 30-day survivors who underwent percutaneous coronary intervention after acute myocardial infarction.

    Science.gov (United States)

    Lee, Jang Hoon; Bae, Myung Hwan; Yang, Dong Heon; Park, Hun Sik; Cho, Yongkeun; Jeong, Myung Ho; Kim, Young Jo; Kim, Kee-Sik; Hur, Seung Ho; Seong, In Whan; Cho, Myeong Chan; Kim, Chong Jin; Chae, Shung Chull

    2015-05-01

    Few simple and effective tools are available for determining the prognosis of 30-day survivors after acute myocardial infarction. We aimed to assess whether the simple age, creatinine, and ejection fraction (ACEF) score could predict 1-year mortality of 12,000 post-myocardial infarction 30-day survivors who underwent percutaneous coronary intervention. The ACEF score was computed as follows: (age/ejection fraction) + 1, if the serum creatinine was >2 mg/dl. Accuracy was defined through receiver-operating characteristics analysis and area under the curve (AUC) evaluation. Twelve risk factors were selected and ranked according to their AUC value. Age, ejection fraction, and serum creatinine levels indicated the best AUC value. The ACEF score was significantly higher in the nonsurvivors (1.95 ± 0.82 vs 1.28 ± 0.50; p risk factors (AUC = 0.80), but this did not significantly differ compared with the AUC (0.79) of the ACEF score (p = ns). Adjusted hazard ratios for 1-year mortality were 1 (reference), 3.11 (p risk in 30-day survivors who underwent percutaneous coronary intervention after acute myocardial infarction. PMID:25772739

  20. Risk profile in young patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    The objective of this study was to determine the frequency of risk factors in young patients with acute myocardial infarction and thus with ischemic heart disease (IHD), aged 20 to 40 years, in our population. All patients who fulfilled the inclusion criteria who presented to emergency reception of the hospital with a diagnosis of Acute MI were included. The patients were admitted to coronary care unit (CCU) and were managed for Acute myocardial infarction (MI). Their detailed history was then taken including symptoms at presentation and their risk factors were assessed with the help of history and laboratory investigations. A total of 137 patients were included during the study period. Mean age was 36 years (SD=3.67). Majority of patients were males. Smoking was the major risk factor (64.2%) followed by family history of IHD (30.7%). Most frequent risk factor for Acute myocardial infarction (MI) at young age is smoking followed by family history. (author)

  1. Development of a Cardiovascular Risk Score for Use in Low- and Middle-Income Countries123

    OpenAIRE

    Aslibekyan, Stella; Campos, Hannia; Loucks, Eric B.; Linkletter, Crystal D.; Ordovas, Jose M.; Baylin, Ana

    2011-01-01

    Summary measures of cardiovascular risk have long been used in public health, but few include nutritional predictors despite extensive evidence linking diet and heart disease. Study objectives were to develop and validate a novel risk score in a case-control study of myocardial infarction (MI) conducted in Costa Rica during 1994–2004. After restricting the data set to healthy participants (n = 1678), conditional logistic regression analyses modeled associations of lifestyle factors (unhealt...

  2. Class of Antiretroviral Drugs and the Risk of Myocardial Infarction

    DEFF Research Database (Denmark)

    Friis-MØller, Nina; Reiss, P

    2007-01-01

    BACKGROUND: We have previously demonstrated an association between combination antiretroviral therapy and the risk of myocardial infarction. It is not clear whether this association differs according to the class of antiretroviral drugs. We conducted a study to investigate the association of cumulative exposure to protease inhibitors and nonnucleoside reverse-transcriptase inhibitors with the risk of myocardial infarction. METHODS: We analyzed data collected through February 2005 from our prospective observational study of 23,437 patients infected with the human immunodeficiency virus. The incidence rates of myocardial infarction during the follow-up period were calculated, and the associations between myocardial infarction and exposure to protease inhibitors or nonnucleoside reverse-transcriptase inhibitors were determined. RESULTS: Three hundred forty-five patients had a myocardial infarction during 94,469 person-years of observation. The incidence of myocardial infarction increased from 1.53 per 1000 person-years in those not exposed to protease inhibitors to 6.01 per 1000 person-years in those exposed to protease inhibitors for more than 6 years. After adjustment for exposure to the other drug class and established cardiovascular risk factors (excluding lipid levels), the relative rate of myocardial infarction per year of protease-inhibitor exposure was 1.16 (95% confidence interval [CI], 1.10 to 1.23), whereas the relative rate per year of exposure to nonnucleoside reverse-transcriptase inhibitors was 1.05 (95% CI, 0.98 to 1.13). Adjustment for serum lipid levels further reduced the effect of exposure to each drug class to 1.10 (95% CI, 1.04 to 1.18) and 1.00 (95% CI, 0.93 to 1.09), respectively. CONCLUSIONS: Increased exposure to protease inhibitors is associated with an increased risk of myocardial infarction, which is partly explained by dyslipidemia. We found no evidence of such an association for nonnucleoside reverse-transcriptase inhibitors; however, the number of person-years of observation for exposure to this class of drug was less than that for exposure to protease inhibitors. Copyright 2007 Massachusetts Medical Society.

  3. Risk factor assessment of young patients with acute myocardial infarction

    Science.gov (United States)

    Jamil, Gohar; Jamil, Mujgan; AlKhazraji, Hind; Haque, Amber; Chedid, Fares; Balasubramanian, Manjula; Khairallah, Bahaa; Qureshi, Anwer

    2013-01-01

    The Middle East represents an attractive area for young individuals to seek employment, where they are exposed to numerous environmental conditions. The pursuit of a better standard of living has driven hundreds to the Middle East over the recent decades. This influx has also resulted in a predisposition to premature coronary artery disease (CAD). The aim of this study was to provide an overview of the risk factors in patients younger than 45 years, presenting with acute myocardial infarction (AMI). Out of the 148 patients analyzed, 137 were males and 11 females. 119 were from South Asia and 29 were Arabs. Their mean age was 36 ± 4.2 years. Smoking was the most prevalent risk factor in both groups at 67.6%. This was followed by hypertension, family history of CAD, hyperlipidemia and Diabetes mellitus. There was no significant difference in the clinical risk factor profile between these two groups. ST elevation myocardial infarction (STEMI) was noted in 67.6%, while 32.4% patients suffered a Non ST elevation myocardial infarction (NSTEMI). 84.5% received coronary stents, 8.8% had lone thrombus aspiration or balloon angioplasty only, while the rest were treated by conservative medical management or referred for coronary artery bypass surgery. Conclusion: There is no significant difference in the CAD risk profile between young South Asian and Arab patients. Preventive strategies focused on risk factor reduction, especially smoking cessation, should be implemented to protect young adults in the most productive years of their life. PMID:23991352

  4. Credit scores, cardiovascular disease risk, and human capital

    OpenAIRE

    Israel, Salomon; Caspi, Avshalom; Belsky, Daniel W.; Harrington, Honalee; Hogan, Sean; Houts, Renate; Ramrakha, Sandhya; Sanders, Seth; Poulton, Richie; Moffitt, Terrie E.

    2014-01-01

    Credit scoring is expanding into domains beyond lending. Today, credit scores are used by employers, utility companies, and automobile insurers to index high-risk behavior. Life insurance companies even incorporate credit scores into actuarial models. This expansion is controversial, as it is unclear what personal attributes credit scores capture. Following 1,000 individuals from birth to midlife, we show that low credit scores predict cardiovascular disease risk. We also show that the reason...

  5. Development of a Cardiovascular Risk Score for Use in Low- and Middle-Income Countries123

    Science.gov (United States)

    Aslibekyan, Stella; Campos, Hannia; Loucks, Eric B.; Linkletter, Crystal D.; Ordovas, Jose M.; Baylin, Ana

    2011-01-01

    Summary measures of cardiovascular risk have long been used in public health, but few include nutritional predictors despite extensive evidence linking diet and heart disease. Study objectives were to develop and validate a novel risk score in a case-control study of myocardial infarction (MI) conducted in Costa Rica during 1994–2004. After restricting the data set to healthy participants (n = 1678), conditional logistic regression analyses modeled associations of lifestyle factors (unhealthy diet, decreased physical activity, smoking, waist:hip ratio, low or high alcohol intake, and low socioeconomic status) with risk for MI. Using the estimated coefficients as weights for each component, a regression model was fit to assess score performance. The score was subsequently validated in participants with a history of chronic disease. Higher risk score values were associated with a significantly increased risk of MI [OR = 2.72 (95% CI = 2.28–3.24)]. The findings were replicated in a model (n = 1392) that included the best covariate measures available in the study [OR = 2.71 (95% CI = 2.26–3.26)]. Performance of the score in different subsets of the study population showed c-statistics ranging from 0.63 to 0.67. The new score presents a quantitative summary of modifiable cardiovascular risk factors in the study population. PMID:21562240

  6. Development of a cardiovascular risk score for use in low- and middle-income countries.

    Science.gov (United States)

    Aslibekyan, Stella; Campos, Hannia; Loucks, Eric B; Linkletter, Crystal D; Ordovas, Jose M; Baylin, Ana

    2011-07-01

    Summary measures of cardiovascular risk have long been used in public health, but few include nutritional predictors despite extensive evidence linking diet and heart disease. Study objectives were to develop and validate a novel risk score in a case-control study of myocardial infarction (MI) conducted in Costa Rica during 1994-2004. After restricting the data set to healthy participants (n = 1678), conditional logistic regression analyses modeled associations of lifestyle factors (unhealthy diet, decreased physical activity, smoking, waist:hip ratio, low or high alcohol intake, and low socioeconomic status) with risk for MI. Using the estimated coefficients as weights for each component, a regression model was fit to assess score performance. The score was subsequently validated in participants with a history of chronic disease. Higher risk score values were associated with a significantly increased risk of MI [OR = 2.72 (95% CI = 2.28-3.24)]. The findings were replicated in a model (n = 1392) that included the best covariate measures available in the study [OR = 2.71 (95% CI = 2.26-3.26)]. Performance of the score in different subsets of the study population showed c-statistics ranging from 0.63 to 0.67. The new score presents a quantitative summary of modifiable cardiovascular risk factors in the study population. PMID:21562240

  7. The stability of myocardial area at risk estimated electrocardiographically in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Carlsen, Esben A; Hassell, Mariëlla E C J

    2014-01-01

    In patients with ST-elevation myocardial infarction (STEMI) the amount of myocardial area at risk (MaR) indicates the maximal potential loss of myocardium if the coronary artery remains occluded. During the time course of infarct evolution ischemic MaR is replaced by necrosis, which results in a decrease in ST segment elevation and QRS complex distortion. Recently it has been shown that combining the electrocardiographic (ECG) Aldrich ST and Selvester QRS scores result in a more accurate estimate of MaR than using either method alone. Therefore, we hypothesized that the combined Aldrich and Selvester score, indicating MaR, is stable until myocardial reperfusion therapy. In a retrospective analysis of a study population of 114 patients, 33 patients were included. The combined Aldrich and Selvester score was determined in ECGs recorded in the ambulance (ECG1) and in the hospital before reperfusion (ECG2). The combined Aldrich and Selvester score was considered stable if the difference between ECG1 and ECG2 was <4.5-percentage point. Stability of the combined Aldrich and Selvester score was observed in 12/33 patients (36.4%), and in regards to anterior and inferior ST elevation in 4/14 patients (28.6%) and 8/19 patients (42.1%), respectively. The median time between the recording of ECG1 and ECG2 was 75minutes, however the changes in ECG scores were independent of the time between ECG recordings. Patients not meeting the stability criterion either had a decrease (9 patients) or increase (12 patients) of the combined Aldrich and Selvester score. In conclusion, the ECG estimated MaR was stable between the earliest recording time and initiation of reperfusion treatment only in a subgroup of the patients with STEMI. The findings of this study may suggest heterogeneity in regards to the development of the MaR and could indicate a potential need for differentiation in the acute treatment.

  8. Risk factor assessment of young patients with acute myocardial infarction

    OpenAIRE

    Jamil, Gohar; Jamil, Mujgan; Alkhazraji, Hind; Haque, Amber; Chedid, Fares; Balasubramanian, Manjula; Khairallah, Bahaa; Qureshi, Anwer

    2013-01-01

    The Middle East represents an attractive area for young individuals to seek employment, where they are exposed to numerous environmental conditions. The pursuit of a better standard of living has driven hundreds to the Middle East over the recent decades. This influx has also resulted in a predisposition to premature coronary artery disease (CAD). The aim of this study was to provide an overview of the risk factors in patients younger than 45 years, presenting with acute myocardial infarction...

  9. Changes in subclinical organ damage vs. in Framingham risk score for assessing cardiovascular risk reduction during continued antihypertensive treatment: a LIFE substudy

    DEFF Research Database (Denmark)

    Olsen, Michael H; Wachtell, Kristian

    2011-01-01

    To investigate whether in-treatment measurements of subclinical organ damage (SOD) assessed by elevated urine albumin/creatinine ratio (UACR) or electrocardiographic left ventricular hypertrophy improved the prediction of the composite cardiovascular endpoint of cardiovascular death, nonfatal myocardial infarction and stroke beyond in-treatment Framingham risk score (FRS).

  10. Incidence of cardiovascular events after kidney transplantation and cardiovascular risk scores: study protocol

    Directory of Open Access Journals (Sweden)

    Lorenzo-Aguiar Dolores

    2011-01-01

    Full Text Available Abstract Background Cardiovascular disease (CVD is the major cause of death after renal transplantation. Not only conventional CVD risk factors, but also transplant-specific risk factors can influence the development of CVD in kidney transplant recipients. The main objective of this study will be to determine the incidence of post-transplant CVD after renal transplantation and related factors. A secondary objective will be to examine the ability of standard cardiovascular risk scores (Framingham, Regicor, SCORE, and DORICA to predict post-transplantation cardiovascular events in renal transplant recipients, and to develop a new score for predicting the risk of CVD after kidney transplantation. Methods/Design Observational prospective cohort study of all kidney transplant recipients in the A Coruña Hospital (Spain in the period 1981-2008 (2059 transplants corresponding to 1794 patients. The variables included will be: donor and recipient characteristics, chronic kidney disease-related risk factors, pre-transplant and post-transplant cardiovascular risk factors, routine biochemistry, and immunosuppressive, antihypertensive and lipid-lowering treatment. The events studied in the follow-up will be: patient and graft survival, acute rejection episodes and cardiovascular events (myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances and peripheral vascular disease. Four cardiovascular risk scores were calculated at the time of transplantation: the Framingham score, the European Systematic Coronary Risk Evaluation (SCORE equation, and the REGICOR (Registre Gironí del COR (Gerona Heart Registry, and DORICA (Dyslipidemia, Obesity, and Cardiovascular Risk functions. The cumulative incidence of cardiovascular events will be analyzed by competing risk survival methods. The clinical relevance of different variables will be calculated using the ARR (Absolute Risk Reduction, RRR (Relative Risk Reduction and NNT (Number Needed to Treat. The ability of different cardiovascular risk scores to predict cardiovascular events will be analyzed by using the c index and the area under ROC curves. Based on the competing risks analysis, a nomogram to predict the probability of cardiovascular events after kidney transplantation will be developed. Discussion This study will make it possible to determine the post-transplant incidence of cardiovascular events in a large cohort of renal transplant recipients in Spain, to confirm the relationship between traditional and transplant-specific cardiovascular risk factors and CVD, and to develop a score to predict the risk of CVD in these patients.

  11. Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups

    DEFF Research Database (Denmark)

    Juul, Nikolai; Gislason, Gunnar

    2015-01-01

    BACKGROUND: Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization. METHODS: Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population. RESULTS: A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users 79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged 79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population. CONCLUSION: Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

  12. Evaluation of Cardiovascular Risk Scores Applied to NASA's Astronant Corps

    Science.gov (United States)

    Jain, I.; Charvat, J. M.; VanBaalen, M.; Lee, L.; Wear, M. L.

    2014-01-01

    In an effort to improve cardiovascular disease (CVD) risk prediction, this analysis evaluates and compares the applicability of multiple CVD risk scores to the NASA Astronaut Corps which is extremely healthy at selection.

  13. Credit scores, cardiovascular disease risk, and human capital.

    Science.gov (United States)

    Israel, Salomon; Caspi, Avshalom; Belsky, Daniel W; Harrington, HonaLee; Hogan, Sean; Houts, Renate; Ramrakha, Sandhya; Sanders, Seth; Poulton, Richie; Moffitt, Terrie E

    2014-12-01

    Credit scores are the most widely used instruments to assess whether or not a person is a financial risk. Credit scoring has been so successful that it has expanded beyond lending and into our everyday lives, even to inform how insurers evaluate our health. The pervasive application of credit scoring has outpaced knowledge about why credit scores are such useful indicators of individual behavior. Here we test if the same factors that lead to poor credit scores also lead to poor health. Following the Dunedin (New Zealand) Longitudinal Study cohort of 1,037 study members, we examined the association between credit scores and cardiovascular disease risk and the underlying factors that account for this association. We find that credit scores are negatively correlated with cardiovascular disease risk. Variation in household income was not sufficient to account for this association. Rather, individual differences in human capital factors—educational attainment, cognitive ability, and self-control—predicted both credit scores and cardiovascular disease risk and accounted for ?45% of the correlation between credit scores and cardiovascular disease risk. Tracing human capital factors back to their childhood antecedents revealed that the characteristic attitudes, behaviors, and competencies children develop in their first decade of life account for a significant portion (?22%) of the link between credit scores and cardiovascular disease risk at midlife. We discuss the implications of these findings for policy debates about data privacy, financial literacy, and early childhood interventions. PMID:25404329

  14. Risk Stratification and Management of Patients with Acute Myocardial Infarction (AMI).

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Grünfeldová, H.; Faltus, Václav; Monhart, Z.; Ryšavá, D.; Velimský, T.; Ballek, L.; Huba?, J.; Tome?ková, Marie; Janský, P.

    Timisoara : Cardiology Clinic of the Emergency County Hospital, 2007. s. 28-29. [International Workshop on the Risk Stratification in Patients with Ischemic Heart Disease . 12.04.2007-13.04.2007, Timisoara] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : pilot registry of acute myocardial infarction * risk stratification in acute myocardial infarction * effects of pharmacotherapy in acute myocardial infarction Subject RIV: BB - Applied Statistics, Operational Research

  15. Global left ventricular longitudinal systolic strain for early risk assessment in patients with acute myocardial infarction treated with primary percutaneous intervention

    DEFF Research Database (Denmark)

    Munk, Kim; Andersen, Niels Holmark

    2012-01-01

    Left ventricular systolic function is a key determinant of outcome after ST-segment elevation myocardial infarction (STEMI). The aim of this study was to study speckle-tracking global longitudinal strain (GLS) for early risk evaluation in STEMI and compare it with left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and end-systolic volume index (ESVI).

  16. Risk factors in young patients of acute myocardial infarction

    International Nuclear Information System (INIS)

    Background: Ischemic heart disease is a leading cause of death throughout the world. CAD has been recognized among younger age group more frequently in recent years. Very limited data is available regarding the prevalence of various risk factors in our younger patients that is why this study was planed. Objectives of the study were to look for the risk factors most prevalent in our young patient of first Acute Myocardial Infarction. And to also look for the number of Risk Factors present in each patient. Methods: We studied 100 consecutive patients from 16-45 years of age presenting with first acute MI. Twelve risk factors were studied namely, gender, family history of premature CAD, smoking hypertension, diabetes, dyslipidemia, obesity, mental stress (type A personality), alcohol, oral contraceptive pills (OCPs), physical activity, and diet. We divided the patients into two groups. Group A with patients 35 years of age or less and group B with patients 36-45 years of age. All risk factors were compared in both the groups. Results: Smoking, diabetes mellitus, dyslipidemia and hypertension were statistically different between the two groups. Frequency wise risk factors were lined up as male sex (91%) Diet (66%), Dyslipidemia (62%), smoking (46%), Type A personality(46%), family history (32%), diabetes mellitus (28%), sedentary lifestyle (26%), hypertension (22%), obesity (17%), alcohol (3%), and OCPs (0%) Most of the patients that is 94% had 3 or more risk factors. Conhat is 94% had 3 or more risk factors. Conclusion: Smoking, hypertension, diabetes and dyslipidemia are the major modifiable risk factors in our young adults. If a young male who is smoker or a young female who is diabetic, presents in emergency room with chest pain, always suspect coronary artery disease. Other conventional risk factors are also prevalent but alcohol and OCPs are not a major health problem for us. (author)

  17. Risk factors for near-term myocardial infarction in apparently healthy men and women

    DEFF Research Database (Denmark)

    Nordestgaard, BØrge; Adourian, Aram S

    2010-01-01

    Limited information is available regarding risk factors for the near-term (4 years) onset of myocardial infarction (MI). We evaluated established cardiovascular risk factors and putative circulating biomarkers as predictors for MI within 4 years of measurement.

  18. Antidiabetic treatments and risk of hospitalisation with myocardial infarction: a nationwide case-control study

    DEFF Research Database (Denmark)

    Horsdal, Henriette Thisted; SØndergaard, Flemming

    2011-01-01

    Data on cardiovascular risk associated with different types of antidiabetic treatments are sparse and conflicting. We examined the risk of hospitalisation with myocardial infarction (MI) among patients treated with sulfonylureas, metformin, insulin, any combination and no antidiabetic pharmacotherapy.

  19. ASSESSMENT OF MYOCARDIAL INFARCTION RISK FACTORS IN AL-NAJAF CITY

    OpenAIRE

    Ibrahim Alwan Kadhim Al-Ashour

    2014-01-01

    Myocardial infarction (MI) is the condition of irreversible necrosis of the heart muscle that is a result of prolonged ischemia. After World War II coronary heart disease (CHD) assumed epidemic proportions in western countries; nowadays, myocardial infarction is the leading cause of death in developed countries. Thus this study is conducted to establish a data base for the factors contributing the incidence of MI in Al-Najaf city. The aim was to assess the myocardial infarction risk facto...

  20. Cardiovascular risk assessment in Italy: the CUORE Project risk score and risk chart

    Directory of Open Access Journals (Sweden)

    Simona Giampaoli

    2007-06-01

    Full Text Available

    Aim: Risk charts and risk score, based on the global absolute risk, are key tools for CVD risk assessment. When applied to the population from which they derive, they provide the best estimate of CVD risk. That is why the CUORE Project has among its objectives the assessment of the Italian population’s cardiovascular risk, identifying the model for the prediction of coronary and cerebrovascular events in 10 years.

    Methods: Data fromdifferent cohorts enrolled in the North, Centre and South of Italy between the 1980s and the 1990s were used. From the 7,056 men and 12,574 women aged 35-69 years, free of cardiovascular disease at base-line and followed up for a mean time of 10 years for total and cause-specific mortality and non fatal cerebrovascular and coronary events, 894 major cardiovascular events (596 coronary and 298 cerebrovascular were identified and validated. To assess 10-year cardiovascular risk, the risk score and risk chart were developed for men and women separately, considering the first major coronary or cerebrovascular event as the endpoint.

    Results: The risk score is applied tomen andwomen aged 35-69 years and includes age, systolic blood pressure, total cholesterol, HDL-cholesterol, smoking habit, diabetes and hypertension treatment using continuous values when possible. The risk chart is applied to persons aged 40-69 years and includes the same risk factors as risk score, except for HDL-cholesterol and hypertension treatment, and uses categorical values for all variables.

    Conclusions: The risk score and risk chart are easy-to-use tools which enable general practitioners and specialists to achieve an objective evaluation of the absolute global cardiovascular risk of middle-aged persons in primary prevention.

  1. Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions.

    LENUS (Irish Health Repository)

    Rodríguez-Granillo, Gastón A

    2012-01-05

    Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue.

  2. Risk score for contrast induced nephropathy following percutaneous coronary intervention

    International Nuclear Information System (INIS)

    Contrast-induced nephropathy (CIN) is an important cause of acute renal failure. Identification of risk factors of CIN and creating a simple risk scoring for CIN after percutaneous coronary intervention (PCI) is important. A prospective single center study was conducted in Kuwait chest disease hospital. All patients admitted to chest disease hospital for PCI from March to May 2005 were included in the study. Total of 247 patients were randomly assigned for the development dataset and 100 for the validation set using the simple random method. The overall occurrence of CIN in the development set was 5.52%. Using multivariate analysis; basal Serum creatinine, shock, female gender, multivessel PCI, and diabetes mellitus were identified as risk factors. Scores assigned to different variables yielded basal creatinine > 115 micron mol/L with the highest score(7), followed by shock (3), female gender, multivessel PCI and diabetes mellitus had the same score (2). Patients were further risk stratified into low risk score (12). The developed CIN model demonstrated good discriminative power in the validation population. In conclusion, use of a simple risk score for CIN can predict the probability of CIN after PCI; this however needs further validation in larger multicenter trials. (author)

  3. Risk factors of postoperative myocardial infarction after colorectal surgeries.

    Science.gov (United States)

    Moghadamyeghaneh, Zhobin; Mills, Steven D; Carmichael, Joseph C; Pigazzi, Alessio; Stamos, Michael J

    2015-04-01

    There are limited data regarding the specific risk factors of postoperative myocardial infarction (MI) in patients undergoing colorectal resectional surgery. We sought to identify risk factors of acute MI after colorectal resection operations. The National Inpatient Sample database was used to identify patients who had postoperative MI after colorectal resection operations between 2002 and 2010. Statistical analysis was performed to identify factors predictive of postoperative MI. We sampled a total of 2,513,124 patients undergoing colorectal resection, of whom 38,317 (1.5%) sustained a postoperative MI. Patients with postoperative MI had associated 28.5 per cent in-hospital mortality. Risk factors identified include (P heart failure (odds ratio [OR], 8.18), chronic renal failure (OR, 3.86), age 70 years or older (OR, 3.68), peripheral vascular disorders (OR, 2.93), fluid and electrolyte disorders (OR, 2.69), emergency admission (OR, 2.56), preoperative weight loss (OR, 2.49), cardiac valvular disease (OR, 2.46), chronic lung disease (OR, 1.75), deficiency anemia (OR, 1.22), colorectal cancer (OR, 1.77), and hypertension (OR, 1.14). Postoperative MI occurs in less than 2 per cent of colorectal resections. However, patients sustaining postoperative MI are over six times more likely to die. Congestive heart failure and chronic renal failure are the strongest predictors of postoperative MI. PMID:25831181

  4. A case-control study of physical activity patterns and risk of non-fatal myocardial infarction

    Directory of Open Access Journals (Sweden)

    Gong Jian

    2013-02-01

    Full Text Available Abstract Background The interactive effects of different types of physical activity on cardiovascular disease (CVD risk have not been fully considered in previous studies. We aimed to identify physical activity patterns that take into account combinations of physical activities and examine the association between derived physical activity patterns and risk of acute myocardial infarction (AMI. Methods We examined the relationship between physical activity patterns, identified by principal component analysis (PCA, and AMI risk in a case-control study of myocardial infarction in Costa Rica (N=4172, 1994-2004. The component scores derived from PCA and total METS were used in natural cubic spline models to assess the association between physical activity and AMI risk. Results Four physical activity patterns were retained from PCA that were characterized as the rest/sleep, agricultural job, light indoor activity, and manual labor job patterns. The light indoor activity and rest/sleep patterns showed an inverse linear relation (P for linearity=0.001 and a U-shaped association (P for non-linearity=0.03 with AMI risk, respectively. There was an inverse association between total activity-related energy expenditure and AMI risk but it reached a plateau at high levels of physical activity (P for non-linearity=0.01. Conclusions These data suggest that a light indoor activity pattern is associated with reduced AMI risk. PCA provides a new approach to investigate the relationship between physical activity and CVD risk.

  5. SCORING THE DEFAULT RISK OF LOCAL AUTHORITY

    Directory of Open Access Journals (Sweden)

    GORI Elena

    2014-06-01

    Full Text Available In the Nineties, almost all public administrations were affected by a change that made municipalities more responsible in using public resources. More recently, the global crisis and the gradual cuts in funding from the State led to significant repercussions on the budgets of local authorities with an increasing number of defaults. The Italian government introduced the procedure of “financial default” to rescue local authorities in financial difficulties from 1989. However, to date, a methodology to constantly monitor the local authorities’ "health" and to prevent financial defaults has not yet been formalized. As previous studies highlighted a close link between financial condition and service delivered to citizens, the study aims to construct a set of specific indicators to judge the default risk of Italian LAs in order to prevent defaults. In this research we use a deductive method. The research was carried out in eight different steps according to a logical process of identifying the risk indicators and the consequent risk ranges. The results are significant as they clarify the situation leading potentially to default and they propose a set of specific risk indicators to evaluate and to prevent the risk of default. This logical process could easily be adopted at an international level, with the necessary modifications for specific accounting regimes.

  6. [Advanced age and risk factors for acute myocardial infarction].

    Science.gov (United States)

    Ciruzzi, Mario A; Schargrosky, Herman; Pramparo, Palmira; Rosloznik, Jorge; Zylbersztejn, Horacio; Haquim, Mónica; Rudich, Viviana; Caccavo, Alberto; Piskorz, Daniel

    2002-01-01

    This case-control study, analyzed the role of coronary risk factors in acute myocardial infarction (AMI) in the elderly, and established the nature of this association and the degree of risk. Data were derived from an investigation (1060 cases and 1071 controls) conducted in 35 coronary care units from clinical centres in Argentina between November 1991 and August 1994. Our analysis was based on data collected from subjects over age 65. Cases were 427 patients with AMI and without history of ischaemic heart disease. Controls were 396 subjects identified in the same centres as the cases. Odds ratios (OR) estimates and their 95% confidence intervals (CI) were derived from multiple logistic regression equations including terms for age, education, social status, smoking status, history of diabetes or hypertension, body mass index and family history of coronary heart disease. The risk factors independently and strongly related to the risk of AMI were the following: hyperlipidemia (serum cholesterol > or = 240 mg/dl): OR = 1.76 (95% CI: 1.25-2.49), smoking habits: OR = 1.6 (95% CI: 1.06-2.4), hypertension: OR = 2.05 (95% CI: 1.51-2.73), diabetes OR = 1.71 (95% CI: 1.12-2.70), one relative with family history of coronary heart disease: OR = 1.36 (95% CI: 0.93-1.97) and two or more relatives: OR = 2.63 (95% CI: 1.21-5.71). This study confirms in the elderly the importance of hyperlipidemia, tobacco, hypertension, diabetes and family history of coronary heart disease as risks factors of AMI. PMID:12532687

  7. Clinical use of the combined Sclarovsky Birnbaum Severity and Anderson Wilkins Acuteness scores from the pre-hospital ECG in ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Fakhri, Yama; Schoos, Mikkel M

    2014-01-01

    This review summarizes the electrocardiographic changes during an evolving ST segment elevation myocardial infarction and discusses associated electrocardiographic scores and the potential use of these indices in clinical practice, in particular the ECG scores developed by Anderson and Wilkins estimating the acuteness of myocardial ischemia and Sclarovsky-Birnbaum's grades of ischemia evaluating the severity of ongoing ischemia.

  8. Acute Myocardial Infarction: The First Manifestation of Ischemic Heart Disease and Relation to Risk Factors

    Directory of Open Access Journals (Sweden)

    Manfroi Waldomiro Carlos

    2002-01-01

    Full Text Available OBJECTIVE: To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. METHODS: We carried out a cross-sectional study of 104 patients with previous acute myocardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. RESULTS: Of the 104 patients studied, 72.1% were males, 90.4% were white, 73.1% were older than 55 years, and 53.8% were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49% of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95% CI=0.06-0.59; P=0.04 and left ventricular hypertrophy (RR=0.27; 95% CI=0,.8-0.88; P=0.03. The remaining risk factors were not statistically significant. CONCLUSION: Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels.

  9. Prospective evaluation of the Paediatric Risk of Mortality (PRISM) score.

    OpenAIRE

    Balakrishnan, G.; Aitchison, T.; Hallworth, D; Morton, N. S.

    1992-01-01

    The performance of the admission day Paediatric Risk of Mortality (PRISM) score for outcome prediction was assessed prospectively in 270 consecutive admissions, aged 3 days to 18.6 years, to a paediatric intensive care unit. Using a cut off of r = 0.00 (expected mortality = 50%), the overall sensitivity (correct prediction of death) was 48% while specificity (correct prediction of survival) was 99%, comparable with the original validation data of the score in the USA. Outcome prediction was m...

  10. Prognostic Value of TIMI Score versus GRACE Score in ST-segment Elevation Myocardial Infarction / Valor Prognóstico do Escore TIMI versus Escore GRACE no Infarto com Supradesnível do Segmento ST

    Scientific Electronic Library Online (English)

    Luis C. L., Correia; Guilherme, Garcia; Felipe, Kalil; Felipe, Ferreira; Manuela, Carvalhal; Ruan, Oliveira; André, Silva; Isis, Vasconcelos; Caio, Henri; Márcia, Noya-Rabelo.

    2014-08-01

    Full Text Available Fundamento: O Escore TIMI para infarto com supradesnível do segmento ST (IAMcSST) foi criado e validado especificamente para este cenário clínico, enquanto o Escore GRACE é genérico para qualquer tipo de síndrome coronariana aguda. Objetivo: Identificar qual dos escores, TIMI ou GRACE, apresen [...] ta melhor desempenho prognóstico em pacientes com IAMcSST. Métodos: Foram incluídos 152 indivíduos consecutivamente internados por IAMcSST. Os escores TIMI e GRACE foram testados quanto a sua capacidade discriminatória (estatística-C) e calibração (teste Hosmer-Lemeshow), em relação ao desfecho óbito hospitalar. Resultados: O Escore TIMI apresentou distribuição equitativa de pacientes nas faixas de baixo, intermediário e alto risco (39%, 27% e 34%, respectivamente), diferente do Escore GRACE que apresentou distribuição predominante em baixo risco (80%, 13% e 7%, respectivamente). A letalidade da amostra foi de 11%. A estatística-C do Escore TIMI foi de 0,87 (95% IC = 0,76 - 0,98), semelhante ao GRACE (0,87; 95% IC = 0,75-0,99) - p = 0,71. O Escore TIMI apresentou calibração satisfatória, representada por ?2 de 1,4 (p = 0,92), nitidamente superior à calibração do Escore GRACE, que apresentou ?2 de 14 (p = 0,08). Esta calibração se reflete em incidências esperadas para as faixas de baixo, intermediário e alto risco de acordo com o Escore TIMI (0%, 4,9% e 25%, respectivamente), diferente do GRACE (2,4%, 25% e 73%) que caracterizou inadequadamente a faixa intermediária. Conclusão: Os escores TIMI e GRACE apresentam semelhante capacidade discriminatória em relação a óbito hospitalar, porém o Escore TIMI possui calibração superior ao GRACE. Para populações de risco diferente da nossa amostra, esta conclusão deve ser validada por futuros trabalhos. Abstract in english Background: The TIMI Score for ST-segment elevation myocardial infarction (STEMI) was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome. Objective: Between TIMI and GRACE scores, identify the one of better pro [...] gnostic performance in patients with STEMI. Methods: We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics) and calibration (Hosmer-Lemeshow) in relation to hospital death. Results: The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively), as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively). Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98), similar to GRACE (0.87, 95%CI = 0.75 to 0.99) - p = 0.71. The TIMI score showed satisfactory calibration represented by ?2 = 1.4 (p = 0.92), well above the calibration of the GRACE score, which showed ?2 = 14 (p = 0.08). This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately. Conclusion: Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.

  11. Risk score model for fatal intracranial hemorrhage in acute leukemia.

    Science.gov (United States)

    Kim, H; Lee, J-H; Choi, S-J; Lee, J-H; Seol, M; Lee, Y S; Kim, W-K; Lee, J-S; Lee, K-H

    2006-05-01

    To build a risk score (RS) model of fatal intracranial hemorrhage (FICH) in patients with acute leukemia, we retrospectively assessed risk factors in 792 patients newly diagnosed with acute leukemia, 41 of whom had analyzable FICH. We found that female gender (relative risk (RR) = 5.234, PFICH in multivariate analysis. To calculate RS for FICH, one point was assigned for each risk factor, making the RS between 0 and 5. The RS model segregated patients into three prognostic groups: a low-risk group (LRG) for RS of 0 or 1; an intermediate-risk group (IRG) for RS of 2 or 3; and a high-risk group (HRG) for RS of 4 or 5. Expectation of FICH was well correlated with risk groups (all P-values FICH will be verified through prospective studies. PMID:16525500

  12. High Framingham risk score decreases quality of life in adults

    Directory of Open Access Journals (Sweden)

    Christian Yosaputra

    2010-04-01

    Full Text Available Cardiovascular disease (CVD risk factors, such as diabetes, hypertension, hypercholesterolemia, smoking, and obesity tend to occur together in the general population. Increasing prevalence of multiple CVD risk factors has been related to increased risk of death from coronary heart disease and stroke. Studies have suggested that people with several risk factors of CVD may have impaired health-related quality of life. The objective of this study was to assess the association of CVD risk factors with quality of life (QOL among adults aged 40 to 65 years. A cross-sectional study was conducted involving 220 subjects 40 - 65 years of age at a health center. The CVD risk factors were assessed using the Framingham risk score that is the standard instrument for assessment of the risk of a first cardiac event. The risk factors assessed were age, smoking, blood pressure, total cholesterol and high density lipoprotein cholesterol concentrations. QOL was assessed by means of the WHOQOL-BREF instrument that had been prevalidated. The results of the study showed that 28.2% of subjects were smokers, 56.4% had stage 1 hypertension, 42.8% high total cholesterol and 13.6% low HDL cholesterol. The high risk group amounted to 45.5% and 42.3% constitued an intermediate risk group. High CVD risk scores were significantly associated with a low QOL for all domains (physical, psychological, social and environment (p=0.000. Preventing or reducing the multiple CVD risk factors to improve QOL is necessary among adults.

  13. Physical activity and myocardial infarction : epidemiological studies on the association between various types of physical activity and the risk of myocardial infarction, including certain aspects of methodology

    OpenAIRE

    Fransson, Eleonor

    2006-01-01

    The aim of this thesis was to study the associations between physical activity during leisure time, occupational and household work, and established risk factors for cardiovascular disease, as well as the risk of acute myocardial infarction. Methodological aspects concerning the presence of recall bias in epidemiological case-control studies on physical activity and myocardial infarction were also considered. The associations between physical activity and hypertension, chol...

  14. C-Reactive protein predicts acute myocardial infarction during high-risk noncardiac and vascular surgery

    Scientific Electronic Library Online (English)

    Oscar M., Martins; Vicente F., Fonseca; Ivan, Borges; Vaierio, Martins; Vera Lucia, Portal; Lucia Campos, Pellanda.

    Full Text Available BACKGROUND: High-sensitivity C-reactive protein predicts cardiovascular events in a wide range of clinical contexts. However, the role of high-sensitivity C-reactive protein as a predictive marker for perioperative acute myocardial infarction during noncardiac surgery is not yet clear. The present s [...] tudy investigated high-sensitivity C-reactive protein levels as predictors of acute myocardial infarction risk in patients undergoing high-risk noncardiac surgery. METHODS: This concurrent cohort study included patients aged >50 years referred for high-risk noncardiac surgery according to American Heart Association/ACC 2002 criteria. Patients with infections were excluded. Electrocardiograms were performed, and biomarkers (Troponin I or T) and/or total creatine phosphokinase and the MB fraction (CPK-T/MB) were evaluated on the first and fourth days after surgery. Patients were followed until discharge. Baseline high-sensitivity C-reactive protein levels were compared between patients with and without acute myocardial infarction. RESULTS: A total of 101 patients undergoing noncardiac surgery, including 33 vascular procedures (17 aortic and 16 peripheral artery revascularizations), were studied. Sixty of the patients were men, and their mean age was 66 years. Baseline levels of high-sensitivity C-reactive protein were higher in the group with perioperative acute myocardial infarction than in the group with non-acute myocardial infarction patients (mean 48.02 vs. 4.50, p = 0.005). All five acute myocardial infarction cases occurred in vascular surgery patients with high CRP levels. CONCLUSIONS: Patients undergoing high-risk noncardiac surgery, especially vascular surgery, and presenting elevated baseline high-sensitivity C-reactive protein levels are at increased risk for perioperative acute myocardial infarction.

  15. Myocardial infarction and risk of suicide: a population-based case-control study

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær; Agerbo, Esben

    2010-01-01

    Myocardial infarction (MI) is associated with an increased risk of anxiety, depression, low quality of life, and all-cause mortality. Whether MI is associated with an increased risk of suicide is unknown. We examined the association between MI and suicide.

  16. Discrepancy between coronary artery calcium score and HeartScore in middle-aged Danes: the DanRisk study

    DEFF Research Database (Denmark)

    Diederichsen, Axel Cosmus Pyndt; Sand, Niels Peter

    2012-01-01

    Background: Coronary artery calcification (CAC) is an independent and incremental risk marker. This marker has previously not been compared to the HeartScore risk model. Design: A random sample of 1825 citizens (men and women, 50 or 60 years of age) was invited for screening. Methods: Using the HeartScore model, the 10-year risk of fatal cardiovascular events based on gender, age, smoking, systolic blood pressure, and total cholesterol was estimated. A low risk was defined as

  17. Comparing patients with spinal cord infarction and cerebral infarction: clinical characteristics, and short-term outcome

    Directory of Open Access Journals (Sweden)

    Romi F

    2011-08-01

    Full Text Available Halvor Naess, Fredrik RomiDepartment of Neurology, Haukeland University Hospital, N-5021 Bergen, NorwayBackground: To compare the clinical characteristics, and short-term outcome of spinal cord infarction and cerebral infarction.Methods: Risk factors, concomitant diseases, neurological deficits on admission, and short-term outcome were registered among 28 patients with spinal cord infarction and 1075 patients with cerebral infarction admitted to the Department of Neurology, Haukeland University Hospital, Bergen, Norway. Multivariate analyses were performed with location of stroke (cord or brain, neurological deficits on admission, and short-term outcome (both Barthel Index [BI] 1 week after symptom onset and discharge home or to other institution as dependent variables.Results: Multivariate analysis showed that patients with spinal cord infarction were younger, more often female, and less afflicted by hypertension and cardiac disease than patients with cerebral infarction. Functional score (BI was lower among patients with spinal cord infarctions 1 week after onset of symptoms (P < 0.001. Odds ratio for being discharged home was 5.5 for patients with spinal cord infarction compared to cerebral infarction after adjusting for BI scored 1 week after onset (P = 0.019.Conclusion: Patients with spinal cord infarction have a risk factor profile that differs significantly from that of patients with cerebral infarction, although there are some parallels to cerebral infarction caused by atherosclerosis. Patients with spinal cord infarction were more likely to be discharged home when adjusting for early functional level on multivariate analysis.Keywords: spinal cord infarction, cerebral infarction, risk factors, short-term outcome

  18. Acute Myocardial Infarction: The First Manifestation of Ischemic Heart Disease and Relation to Risk Factors

    Scientific Electronic Library Online (English)

    Waldomiro Carlos, Manfroi; Carolina, Peukert; Clarissa Bacha, Berti; Clarissa, Noer; Danielle de Ávila, Gutierres; Felipe Theodoro Bezerra Gaspar Carvalho da, Silva.

    2002-04-01

    Full Text Available OBJECTIVE: To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. METHODS: We carried out a cross-sectional study of 104 patients with previous acute myo [...] cardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. RESULTS: Of the 104 patients studied, 72.1% were males, 90.4% were white, 73.1% were older than 55 years, and 53.8% were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49% of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95% CI=0.06-0.59; P=0.04) and left ventricular hypertrophy (RR=0.27; 95% CI=0,.8-0.88; P=0.03). The remaining risk factors were not statistically significant. CONCLUSION: Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels.

  19. Metabolic syndrome and Framingham risk score in obese young adults

    OpenAIRE

    Felix F. Widjaja; Ivan R. Widjaja; Yuni Astria; Christopher S. Suwita; Sarwono Waspadji

    2013-01-01

    Background: The increase number of the metabolic syndrome (MetS) among young adults was mostly caused by obesity. MetS increases the risk of coronary heart disease (CHD) which can be estimated by Framingham risk score (FRS). The study was aimed to know the prevalence of MetS and FRS in obese young adults and to associate them with the components of MetS. Methods: A total of 70 male and female students aged 18 to 25 years with BMI ? 25 kg/m2 in Faculty of Medicine Universitas Indonesia were ...

  20. Myocardial infarction (heart attack) and its risk factors: a statistical study

    International Nuclear Information System (INIS)

    A Statistical technique of odds ratio analysis was performed to look at the association of Myocardial Infarction with sex, smoking, hypertension, cholesterol, diabetes, family history, number of dependents, household income and residence. For this purpose a total of 506 patients were examined and their personal and medical data were collected. For each patient, the phenomenon of myocardial infarction was studied in relation to different risk factors. The analysis suggests that smoking, hypertension, cholesterol level, diabetes, family history are important risk factors for the occurrence of MI. (author)

  1. Posttraumatic Stress and Myocardial Infarction Risk Perceptions in Hospitalized Acute Coronary Syndrome Patients

    OpenAIRE

    Edmondson, Donald; Shaffer, Jonathan A.; Denton, Ellen-ge; Shimbo, Daichi; Clemow, Lynn

    2012-01-01

    Posttraumatic stress disorder (PTSD) is related to acute coronary syndrome (ACS; i.e., myocardial infarction or unstable angina) recurrence and poor post-ACS adherence to medical advice. Since risk perceptions are a primary motivator of adherence behaviors, we assessed the relationship of probable PTSD to ACS risk perceptions in hospitalized ACS patients (n?=?420). Participants completed a brief PTSD screen 3–7?days post-ACS, and rated their 1-year ACS recurrence risk relative to othe...

  2. Depression in silent lacunar infarction: a cross-sectional study of its association with location of silent lacunar infarction and vascular risk factors

    OpenAIRE

    Wu, Ri-Han; Li, Qiang; Tan, Yan; Liu, Xue-Yuan; HUANG Jing

    2014-01-01

    Most previous studies reported a close link between fresh infarcts and post-stroke depression. However, studies on the relation of depression and silent lacunar infarction (SLI) are limited. This study aims to analyze the effects of SLI and the vascular risk factors on depression. A total of 243 patients with SLI were divided into depression and non-depression groups. The presence and location of SLI were evaluated with magnetic resonance imaging. Depression was assessed with the Patient Heal...

  3. Risk factors for acute myocardial infarction during the postoperative period of myocardial revascularization

    Scientific Electronic Library Online (English)

    José Ribamar, Costa Jr.; Dinaldo C., Oliveira; Alexei, DerBedrossian; Enilton T., Egito; Edson R., Romano; Marcos O., Barbosa; Ieda M., Liguori; Jorge, Fahran; Luis C. B., Souza; Adib D., Jatene; Leopoldo S., Piegas.

    2003-03-01

    Full Text Available OBJECTIVE: To identify risk factors for acute myocardial infarction during the postoperative period after myocardial revascularization. METHODS: This was a case-control study paired for sex, age, number, type of graft used, coronary endarterectomy, type of myocardial protection, and use of extracorp [...] oreal circulation. We assessed 178 patients (89 patients in each group) undergoing myocardial revascularization, and the following variables were considered: dyslipidemia, systemic hypertension, smoking, diabetes mellitus, previous myocardial revascularization surgery, previous coronary angioplasty, and acute myocardial infarction. RESULTS: Baseline clinical characteristics did not differ in the groups, except for previous myocardial revascularization surgery, prevalent in the case group (34 patients vs. 12 patients; p = 0.0002). This was the only independent predictor of risk for acute myocardial infarction in the postoperative period, based on a multivariate logistic regression analysis (p=0.0001). Mortality and the time of hospital stay of the case group were significantly higher (19.1% vs. 1.1%; p

  4. Risk for Myocardial Infarction and Stroke after Community-Acquired Bacteremia : A 20-Year Population-Based Cohort Study

    DEFF Research Database (Denmark)

    Dalager-Pedersen, Michael; SØgaard, Mette

    2014-01-01

    Infections may trigger acute cardiovascular events, but the risk after community-acquired bacteremia is unknown. We assessed the risk for acute myocardial infarction and ischemic stroke within 1 year of community-acquired bacteremia.

  5. Antioxidants in adipose tissue and risk of myocardial infarction: the EURAMIC Study.

    Science.gov (United States)

    Kardinaal, A F; Kok, F J; Ringstad, J; Gomez-Aracena, J; Mazaev, V P; Kohlmeier, L; Martin, B C; Aro, A; Kark, J D; Delgado-Rodriguez, M

    1993-12-01

    Laboratory and epidemiological studies suggest that the antioxidants, vitamin E and beta-carotene, protect against coronary heart disease. In a European multicentre case-control study alpha-tocopherol and beta-carotene concentrations were measured in adipose-tissue samples collected in 1991-92 from 683 people with acute myocardial infarction and 727 controls. Mean adipose-tissue beta-carotene concentration was 0.35 microgram/g in cases and 0.42 in controls, with age-adjusted and centre-adjusted mean difference 0.07 microgram/g (95% confidence interval [CI] 0.04-0.10). Mean alpha-tocopherol concentrations were 193 micrograms/g and 192 micrograms/g for cases and controls, respectively. The age-adjusted and centre-adjusted odds ratio for risk of myocardial infarction in the lowest quintile of beta-carotene as compared with the highest was 2.62 (95% CI 1.79-3.83). Additional control for body-mass index and smoking reduced the odds ratio to 1.78 (95% CI 1.17-2.71); other established risk factors did not substantially alter this ratio. The increased risk was mainly confined to current smokers: the multivariate odds ratio in the lowest beta-carotene quintile in smokers was 2.39 (95% CI 1.35-4.25), whereas it was 1.07 for people who had never smoked. A low alpha-tocopherol concentration was not associated with risk of myocardial infarction. Our results support the hypothesis that high beta-carotene concentrations within the normal range reduce the risk of a first myocardial infarction. The findings for alpha-tocopherol are compatible with previous observations of reduced risk among vitamin E supplement users only. The consumption of beta-carotene-rich foods such as carrots and green-leaf vegetables may reduce the risk of myocardial infarction. PMID:7901680

  6. Smoking and risk of myocardial infarction in women and men : longitudinal population study

    DEFF Research Database (Denmark)

    Prescott, E; Hippe, M

    1998-01-01

    OBJECTIVE: To compare risk of myocardial infarction associated with smoking in men and women, taking into consideration differences in smoking behaviour and a number of potential confounding variables. DESIGN: Prospective cohort study with follow up of myocardial infarction. SETTING: Pooled data from three population studies conducted in Copenhagen. SUBJECTS: 11,472 women and 13,191 men followed for a mean of 12.3 years. MAIN OUTCOME MEASURES: First admission to hospital or death caused by myocardial infarction. RESULTS: 1251 men and 512 women had a myocardial infarction during follow up. Compared with non-smokers, female current smokers had a relative risk of myocardial infarction of 2.24 (range 1.85-2.71) and male smokers 1.43 (1.26-1.62); ratio 1.57 (1.25-1.97). Relative risk of myocardial infarction increased with tobacco consumption in both men and women and was higher in inhalers than in non-inhalers. The risks associated with smoking, measured by both current and accumulated tobacco exposure, wereconsistently higher in women than in men and did not depend on age. This sex difference was not affected by adjustment for arterial blood pressure, total and high density lipoprotein cholesterol concentrations, triglyceride concentrations, diabetes, body mass index, height, alcohol intake, physical activity, and level of education. CONCLUSION: Women may be more sensitive than men to some of the harmful effects of smoking. Interactions between components of smoke and hormonal factors that may be involved in development of ischaemic heart disease should be examined further.

  7. Coronary age as a risk factor in the modified Framingham risk score

    OpenAIRE

    Whitcomb Brian W; Schisterman Enrique F

    2004-01-01

    Abstract Background Clinical guidelines emphasize risk assessment as vital to patient selection for medical primary intervention. However, risk assessment methods are restricted in their ability to predict further coronary events. The most widely accepted tool in the United States is the Framingham risk score. In these equations age is a powerful risk factor. Although the extent of coronary atherosclerosis increases with age, there is large inter-individual variability in the rate of developm...

  8. Validación del score de riesgo TIMI para pacientes con síndrome coronario agudo sin elevación del ST TIMI risk score validation for patients with acute coronary syndrome without ST elevation

    Directory of Open Access Journals (Sweden)

    Rodrigo H. Bagur

    2009-10-01

    Full Text Available Los síndromes coronarios agudos sin elevación del segmento ST (SCA-SST son causa frecuente de hospitalización, siendo responsables del 10 al 15% de infartos de miocardio (IM o muertes al año. El objetivo fue evaluar eventos cardiovasculares a 6 meses de seguimiento y validar el score de riesgo TIMI (Thrombolysis in Myocardial Infarction en nuestra población. Se analizaron retrospectivamente pacientes con diagnóstico de SCA-SST. Se realizó seguimiento telefónico a los 6 meses del ingreso. Los puntos finales evaluados fueron la combinación de muerte, internación por síndrome coronario agudo y necesidad de revascularización. Se incluyeron 204 pacientes. El 70.2% eran hombres, edad promedio de 64.5 ± 11.8 años. Luego de la evaluación inicial, se hizo diagnóstico de angina inestable en el 34.6%, IM en 38.9% y el 26.4% fueron catalogados como "dolor no coronario". Al aplicar el score de TIMI, 52 (25.5% pacientes tenían riesgo bajo, 106 (52% riesgo intermedio, y 46 (22.5% riesgo alto. La mortalidad global fue 12.6%. Se encontró un incremento progresivo y significativo en la tasa de eventos combinados a medida que aumentaba el score de TIMI (p Non-ST elevation acute coronary syndromes (NSTE-ACS are frequent cause of hospitalization, being responsible for 10-15% of infarcts or deaths per year. The study was designed to analyze 6 months follow-up of cardiovascular events as well as to validate the Thrombolysis in Myocardial Infarction (TIMI risk score for patients hospitalized for NSTE-ACS. We retrospectively analyzed patients admitted with NSTE-ACS. Telephone follow-up were performed at 6 month. Combination of death, re-admission for acute coronary syndrome and revascularization were considered as end point. Two hundred and four patients were included for the analysis. There were 70.2% males, with a mean age of 64.5 ± 11.8 years. After the initial evaluation, we diagnosed unstable angina in 34.6% of cases, MI in 38.9% of cases, and 26.4% of patients were categorized as "non coronary chest pain". Applying the TIMI risk score, 52 (25.5% patients had low risk, 106 (52% intermediated risk, and 46 (22.5% high risk. The global mortality was 12.3%. We found a progressively and significant increase in the rate of combined events as the TIMI score increase (p < 0.001. We conclude that in our population, the intermediated and high TIMI risk score was well related to newer cardiovascular events at 6 month follow-up.

  9. Fatty Acid Desaturase Gene Variants, Cardiovascular Risk Factors, and Myocardial Infarction in the Costa Rica Study

    OpenAIRE

    Aslibekyan, S.; Linkletter, C. D.; Loucks, E. B.; Ordovas, J. M.; Deka, R.; Baylin, A; Jensen, Majken Karoline; Campos, Hannia; Rimm, Eric B.

    2012-01-01

    Genetic variation in fatty acid desaturases (FADS) has previously been linked to long-chain polyunsaturated fatty acids (PUFAs) in adipose tissue and cardiovascular risk. The goal of our study was to test associations between six common FADS polymorphisms (rs174556, rs3834458, rs174570, rs2524299, rs174589, rs174627), intermediate cardiovascular risk factors, and non-fatal myocardial infarction (MI) in a matched population based case–control study of Costa Rican adults (n = 1756). Generaliz...

  10. The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size

    Scientific Electronic Library Online (English)

    Chao, Feng; Xue, Bai; Yu, Xu; Ting, Hua; Xue-Yuan, Liu.

    Full Text Available OBJECTIVE: Silent brain infarctions are the silent cerebrovascular events that are distinguished from symptomatic lacunar infarctions by their 'silence'; the origin of these infarctions is still unclear. This study analyzed the characteristics of silent and symptomatic lacunar infarctions and sought [...] to explore the mechanism of this 'silence'. METHODS: In total, 156 patients with only silent brain infarctions, 90 with only symptomatic lacunar infarctions, 160 with both silent and symptomatic lacunar infarctions, and 115 without any infarctions were recruited. Vascular risk factors, leukoaraiosis, and vascular assessment results were compared. The National Institutes of Health Stroke Scale scores were compared between patients with only symptomatic lacunar infarctions and patients with two types of infarctions. The locations of all of the infarctions were evaluated. The evolution of the two types of infarctions was retrospectively studied by comparing the infarcts on the magnetic resonance images of 63 patients obtained at different times. RESULTS: The main risk factors for silent brain infarctions were hypertension, age, and advanced leukoaraiosis; the main factors for symptomatic lacunar infarctions were hypertension, atrial fibrillation, and atherosclerosis of relevant arteries. The neurological deficits of patients with only symptomatic lacunar infarctions were more severe than those of patients with both types of infarctions. More silent brain infarctions were located in the corona radiata and basal ganglia; these locations were different from those of the symptomatic lacunar infarctions. The initial sizes of the symptomatic lacunar infarctions were larger than the silent brain infarctions, whereas the final sizes were almost equal between the two groups. CONCLUSIONS: Chronic ischemic preconditioning and nonstrategic locations may be the main reasons for the 'silence' of silent brain infarctions.

  11. The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size

    Directory of Open Access Journals (Sweden)

    Chao Feng

    2013-01-01

    Full Text Available OBJECTIVE: Silent brain infarctions are the silent cerebrovascular events that are distinguished from symptomatic lacunar infarctions by their 'silence'; the origin of these infarctions is still unclear. This study analyzed the characteristics of silent and symptomatic lacunar infarctions and sought to explore the mechanism of this 'silence'. METHODS: In total, 156 patients with only silent brain infarctions, 90 with only symptomatic lacunar infarctions, 160 with both silent and symptomatic lacunar infarctions, and 115 without any infarctions were recruited. Vascular risk factors, leukoaraiosis, and vascular assessment results were compared. The National Institutes of Health Stroke Scale scores were compared between patients with only symptomatic lacunar infarctions and patients with two types of infarctions. The locations of all of the infarctions were evaluated. The evolution of the two types of infarctions was retrospectively studied by comparing the infarcts on the magnetic resonance images of 63 patients obtained at different times. RESULTS: The main risk factors for silent brain infarctions were hypertension, age, and advanced leukoaraiosis; the main factors for symptomatic lacunar infarctions were hypertension, atrial fibrillation, and atherosclerosis of relevant arteries. The neurological deficits of patients with only symptomatic lacunar infarctions were more severe than those of patients with both types of infarctions. More silent brain infarctions were located in the corona radiata and basal ganglia; these locations were different from those of the symptomatic lacunar infarctions. The initial sizes of the symptomatic lacunar infarctions were larger than the silent brain infarctions, whereas the final sizes were almost equal between the two groups. CONCLUSIONS: Chronic ischemic preconditioning and nonstrategic locations may be the main reasons for the 'silence' of silent brain infarctions.

  12. Practical use of the Framingham risk score in primary prevention

    Science.gov (United States)

    Bosomworth, N. John

    2011-01-01

    Abstract Objective To review the 2009 Canadian Cardiovascular Society guidelines and provide practical recommendations for physicians. Sources of information Initial review of the references provided with the guidelines led to a search of the PubMed, ACP Journal Club, and Cochrane databases using the key words primary prevention and statin for English-language clinical trials, randomized controlled trials, meta-analyses, and reviews conducted with human participants. References from appropriate retrieved articles were also reviewed. Main message The guidelines outline low-density lipoprotein cholesterol (LDL-C) thresholds and targets to inform optimal use of statins in the primary prevention of cardiovascular disease (CVD). Family history of CVD and levels of high-sensitivity C-reactive protein (hsCRP) are risk modifiers in calculating the risk score with the new recommendations. An electronic calculator has been developed to facilitate increased uptake of these guidelines. Large numbers of asymptomatic people, particularly the elderly, will become eligible for statin therapy according to these new guidelines. Poor uptake by physicians and patients might result from the need for repeated testing of hsCRP and LDL-C levels in people who do not perceive themselves to be ill. Controversy persists concerning the role of hsCRP in the reclassification of CVD risk, and the concept of treating LDL-C to target has never been tested as an independent variable in a randomized trial. As two-thirds of the LDL-C lowering achieved by a statin occurs at the initial dose, it might be possible to achieve considerable CVD risk reduction for those at risk by treating initially with a mid-dose statin without LDL-C follow-up. Conclusion A simplified approach might appeal to patients or physicians who find current guidelines too complex, cumbersome, or costly. Success in getting high-risk patients to take statins is key to achieving improved CVD mortality reduction. PMID:21626897

  13. Coronary calcium score as a predictor for coronary artery disease and cardiac events in Japanese high-risk patients

    International Nuclear Information System (INIS)

    Although the coronary artery calcium (CAC) score as measured with computed tomography (CT) is associated with cardiovascular mortality and morbidity in Western countries, little is known in Asian populations. Three hundred and seventeen Japanese patients (205 men and 112 women) were followed in the study and they underwent both coronary angiography and CT for CAC measurements. The frequencies of angiographic coronary artery disease (CAD) were 5%, 36%, 76%, 80%, and 94% (P1,000 (n=49), respectively. In the average of 6.0 (range, 1-10) years follow-up period, 34 patients died including 13 from reasons of cardiac disease. In a Cox proportional hazard model after adjustment for age and sex, traditional coronary risk factors, previous myocardial infarction, and the need for revascularization, the hazard ratio for cardiac mortality in patients with a CAC score >1,000 was 2.98 (95% confidence interval: 1.15-9.40) compared with those with a CAC score=0-100. The CAC score has a predictive value for angiographical CAD and long-term mortality from cardiac disease in Japanese high-risk patients who undergo coronary angiography. (author)

  14. MODALITY OF DETERMINING THE TOTAL SCORE OF RISKS IN INTERNAL AUDIT

    OpenAIRE

    FRANCA DUMITRU; MARIA MORARU

    2012-01-01

    Risk analysis materializes in: applying to the weightings of risk factors the level of risk assessment, on risk factors, based on the assessments made by auditors regarding: the functionality of internal control, the influence of quantitative and qualitative elements; determination of the total risk score, which represents a sum of weights between the appreciation level of each risk and the weightings of risk factors.

  15. SCORING ASSESSMENT AND FORECASTING MODELS BANKRUPTCY RISK OF COMPANIES

    Directory of Open Access Journals (Sweden)

    SUSU Stefanita

    2014-07-01

    Full Text Available Bankruptcy risk made the subject of many research studies that aim at identifying the time of the bankruptcy, the factors that compete to achieve this state, the indicators that best express this orientation (the bankruptcy. The threats to enterprises require the managers knowledge of continually economic and financial situations, and vulnerable areas with development potential. Managers need to identify and properly manage the threats that would prevent achieving the targets. In terms of methods known in the literature of assessment and evaluation of bankruptcy risk they are static, functional, strategic, and scoring nonfinancial models. This article addresses Altman and Conan-Holder-known internationally as the model developed at national level by two teachers from prestigious universities in our country-the Robu-Mironiuc model. Those models are applied to data released by the profit and loss account and balance sheet Turism Covasna company over which bankruptcy risk analysis is performed. The results of the analysis are interpreted while trying to formulate solutions to the economic and financial viability of the entity.

  16. Frequency of risk factors of cerebral infarction in stroke patients. a study of 100 cases in naseer teaching hospital, peshawar

    International Nuclear Information System (INIS)

    To study the risk factors of cerebral infarction in stroke patients. It is a descriptive hospital based study conducted at the Department of Medicine, Naseer Teaching Hospital, Peshawar from January 2005 to December 2005. One hundred patients of stroke with cerebral infarction confirmed on C.T. scan brain and more than twenty years of age were included. Risk factors for cerebral infarction were defined in terms of hypertension, diabetes mellitus, ischemic heart disease, smoking, dyslipidaemia, TIAs (transient ischemic attacks), carotid artery stenosis and family history of stroke. Data of 100 cases with cerebral infarction was recorded. Most of the patients had more than one risk factors for cerebral infarction. hypertension was commonest risk factor (55%), smoking (30%), ischemic heart disease (34%), diabetes mellitus) (26%), hyperlipedaemia (30%), atrial fibrillation (25%), carotid artery stenosis (27%), obesity (15%) and family history of stroke (12%). 39% of patients had physical inactivity. Males were slightly predominant than females (51% vs 49%) and mean age was 50 years. females were rather older with mean age of 53 years. Cerebral infarction accounts for 80% to 85% of cases of stroke, which is a common neurological disorder. It increases a burden of disability and misery for patients and their families. Most of the risk factors of cerebral infarction are modifiable, its prevention should be the main cause of concern for the community. (author)or the community. (author)

  17. [The identification of high-risk pregnancy, using a simplified antepartum risk-scoring system].

    Science.gov (United States)

    Cho, C H

    1991-01-01

    This study was carried out to assess the problems with the pregnant women, and check out the risk-factors in the high-risk pregnancies, using a simplified antepartum risk-scoring system, which was revised from Edwards' scoring system to be suitable for Korean situation. This instrument was included 4 categories, demographic, obstetric, medical and miscellaneous factors. This survey was based on the 1300 pregnant women who were admitted, from Jan. 1, 1988, to May 31, 1990, Chung Ang Medical Center. Data were collected from June 25, 1990 to July 7, 1990. Data was analyzed by x2-test, F-test, Pearsons correction, using statistical package SAS in NAS computer system, KIST. The results of the study were as follows; 1. 1313 infants were deliveried of these 560 infants (42.7%) were born to mothers with risk-scores greater than 7, and 753 infants (57.3%) were born to mothers risk-scores less than 7. 2. Maternal age, parity, education level, of the demographic factors were significant relation statistically to identify the high risk pregnancies (X2 = 20.88, 42.87, 15.60 P less than 0.01). 3. C-section, post term, incompetent cervix, uterine anomaly, polyhydramnios, congenital anomaly, sensitized RH negative, abortion, preeclampsia, excessive size infant, premature, low birth weight infant, abnormal presentation, perinatal loss, multiple pregnancy, of the obstetric factors were significant relation statistically to identify the high risk-pregnancies. (chi 2 = 175.96, 87.5, 16.28, 21.78, 9.46, 8.10, 6.75, 22.9, 64.84, 6.93, 361.43, 185.55, 78.65, 45.52, P less than 0.01). 4. Abnormal nutrition, anemia, UTI, other medical condition (pulmonary disease, severe influenza), heart disease, V.D., of the miscellaneous and medical factors, were significant relation statistically to identify the high risk-pregnancies. 5. Premature, low birth weight infant, contracted pelvis, abnormal presentation, of the risk factors were significantly related with Apgar score at 1 & 5 minute after birth and neonatal body weight. 6. Apgar score at 1 & 5 minute after birth and neonatal body weight were significantly negative correlated with risk-score. 7. There were statistically significant difference between risk-score and Apgar score at 1 & 5 minute after birth, 3 group (0-3, 4-6, above 7), and neonatal body weight, 2 group (below 2.5 kg, the other group) (F = 104.65, 96.61, 284.92, P less than 0.01). 8. Apgar score at 1 & 5 minute after birth (below 7), and neonatal body weight (below 2.5 kg), were significant relation statistically with risk score. (chi 2 = 65.99, 60.88, 177.07, P less than 0.01) were 60.8%, 60%.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:1921277

  18. Relation of asymmetric dimethylarginine levels with conventional risk score systems in the healthy subjects with positive family history for coronary artery disease

    Directory of Open Access Journals (Sweden)

    Hulusi Sat?lm??o?lu

    2011-03-01

    Full Text Available Objective: Coronary artery disease is the most common cause of death in Turkey and the world. Asymmetric dimethylarginine is the major inhibitor of nitric oxide synthesis in humans. It has been shown that increased levels of asymmetric dimethylarginine is associated with endothelial dysfunction and increased atherogenesis. In this study, we aimed to investigate whether asymmetric dimethylarginine level is related with conventional risk score systems in subjects who had family history of coronary artery disease. Methods: Fifty two subjects within 20-40 years old of whom first degree relatives had myocardial infarction at young ages and 26 age and sex matched control subjects were included in this cross-sectional observational study. Frequency of diabetes, hyperlipidemia, smoking and serum levels of homocysteine, high-sensitive C-reactive protein (hsCRP and asymmetric dimethylarginine were compared between risk group and control subjects. Relation of asymmetric dimethylarginine level with Framingham and TEKHARF risk scores was also compared. Chi-square and Mann-Whitney U tests were used to compare categorical and continuous variables, respectively.Results: Fasting serum glucose, triglyceride, high-density lipoprotein, diastolic blood pressure, waist circumference and TEKHARF scores were increased in the subjects who had family history of myocardial infarction. Total cholesterol, low-density lipoprotein, hsCRP, homocysteine, creatinine and Framingham risk score were similar in studied groups . Asymmetric dimethylarginine levels were 0.1µmol/L higher in the risk group; however this difference could not reach significance (0.7±0.1 µmol/l vs 0.8±0.1 µmol/l; p=0.061. Conclusion: Measurement of serum asymmetric dimethylarginine levels did not reveal utility in defining conventional coronary artery disease risk score systems in cases that had positive family history. Larger studies including patients with different risk tertiles are needed.

  19. Evaluation of association between obstructive sleep apnea and coronary risk scores predicted by tomographic coronary calcium scoring in asymptomatic patients

    Directory of Open Access Journals (Sweden)

    Alper Kepez

    2011-08-01

    Full Text Available Objective: This cross-sectional observational study is designed to evaluate direct effects of obstructive sleep apnea syndrome (OSA on presence and extent of coronary atherosclerosis by using tomographic coronary calcification scoring on a population asymptomatic for coronary artery disease.Methods: Ninety-seven consecutive patients (49.17±0.86 years who were evaluated with sleep study for the suspicion of obstructive sleep apnea syndrome underwent tomographic coronary calcium scoring test. Cardiovascular risk factors, current medications and sleep study recordings of all patients were recorded. Patients were classified into 4 groups according to the apnea-hypopnea index (AHI. Linear and logistic regression analyses were used for assessment of association between variables.Results: Coronary risk scores of patients, assessed by tomographic coronary calcium scoring, were observed to increase linearly from simple snoring group to severe OSA groups (p=0.046. When patients were classified according to their gender, AHI and parameters reflecting severity of OSA-related hypoxia were found to correlate significantly with coronary risk scores of women but not with scores of men. Linear regression analysis revealed age as the only independent associated variable with cardiovascular risk scores assessed by tomographic coronary calcification scoring (Beta coefficient: 0.27, 95% CI 0.007-0.087, p=0.018. Binary logistic regression analysis also revealed age as the only variable which independently predicted the presence of coronary calcification (OR:1.11, 95% CI 1.039-1.188, p=0.002.Conclusion: These results suggest that presence of OSA may contribute to coronary artery disease risk of patients in association with its severity; however, association between OSA and subclinical atherosclerosis seems to be primarily dependent on age.

  20. Metabolic syndrome and Framingham risk score in obese young adults

    Directory of Open Access Journals (Sweden)

    Felix F. Widjaja

    2013-06-01

    Full Text Available Background: The increase number of the metabolic syndrome (MetS among young adults was mostly caused by obesity. MetS increases the risk of coronary heart disease (CHD which can be estimated by Framingham risk score (FRS. The study was aimed to know the prevalence of MetS and FRS in obese young adults and to associate them with the components of MetS. Methods: A total of 70 male and female students aged 18 to 25 years with BMI ? 25 kg/m2 in Faculty of Medicine Universitas Indonesia were selected consecutively. The blood samples used to test fasting blood glucose, total cholesterol, high-density lipoprotein, and triglyceride were examined in Department of Clinical Pathology, Cipto Mangunkusumo Hospital after fasting for 14 to 16 hours. International Diabetes Federation (IDF definition was used to diagnose MetS. Univariate and bivariate analysis were done. Results: The prevalence of MetS based on IDF definition was 18.6% among obese young adults. The most associated MetS components was hypertriglyceridemia (OR 12.13; 95% CI 2.92-50.46; p = 0.001, followed with high blood pressure (OR 9.33; 95% CI 2.26-38.56; p = 0.001, low-HDL (OR 8.33; 95% CI 2.17-32.05; p = 0.003, and impaired fasting glucose (p = 0.03. Four subjects had FRS ? 1% and 66 subjects had risk < 1%. Increased FRS was not associated with MetS (p = 0.154. There was no component of MetS associated with increased FRS. Conclusion: Prevalence of MetS in obese young adults was similar with obese children and adolescents. Although no association of MetS and FRS was found, they are significant predictors for CHD which should not be used separately. (Med J Indones. 2013;22:100-6Keywords: Abdominal obesity, Framingham risk score, metabolic syndrome, young adults

  1. Acetaminophen use and risk of myocardial infarction and stroke in a hypertensive cohort.

    Science.gov (United States)

    Fulton, Rachael L; Walters, Matthew R; Morton, Ross; Touyz, Rhian M; Dominiczak, Anna F; Morrison, David S; Padmanabhan, Sandosh; Meredith, Peter A; McInnes, Gordon T; Dawson, Jesse

    2015-05-01

    Recent data suggest that self-reported acetaminophen use is associated with increased risk of cardiovascular events and that acetaminophen causes a modest blood pressure rise. There are no randomized trials or studies using verified prescription data of this relationship. We aimed to assess the relationship between verified acetaminophen prescription data and risk of myocardial infarction or stroke in patients with hypertension. We performed a retrospective data analysis using information contained within the UK Clinical Research Practice Datalink. Multivariable Cox proportional hazard models were used to estimate hazard ratios for myocardial infarction (primary end point), stroke, and any cardiovascular event (secondary end points) associated with acetaminophen use during a 10-year period. Acetaminophen exposure was a time-dependent variable. A propensity-matched design was also used to reduce potential for confounding. We included 24?496 hypertensive individuals aged ?65 years. Of these, 10?878 were acetaminophen-exposed and 13?618 were not. There was no relationship between risk of myocardial infarction, stroke, or any cardiovascular event and acetaminophen exposure on adjusted analysis (hazard ratio, 0.98; 95% confidence interval, 0.76-1.27; hazard ratio, 1.09; 95% confidence interval, 0.86-1.38; and hazard ratio, 1.17; 95% confidence interval, 0.99-1.37; respectively). Results in the propensity-matched sample (n=4000 per group) and when men and women were analyzed separately were similar. High-frequency users (defined as receiving a prescription for >75% of months) were also not at increased risk. After allowance for potentially confounding variables, the use of acetaminophen was not associated with an increased risk of myocardial infarction or stroke in a large cohort of hypertensive patients. PMID:25801870

  2. Validación del score de riesgo TIMI para pacientes con síndrome coronario agudo sin elevación del ST / TIMI risk score validation for patients with acute coronary syndrome without ST elevation

    Scientific Electronic Library Online (English)

    Rodrigo H., Bagur; Fernando M., Urinovsky; Alejandro E., Contreras; Carlos D., Estrada.

    2009-10-01

    Full Text Available Los síndromes coronarios agudos sin elevación del segmento ST (SCA-SST) son causa frecuente de hospitalización, siendo responsables del 10 al 15% de infartos de miocardio (IM) o muertes al año. El objetivo fue evaluar eventos cardiovasculares a 6 meses de seguimiento y validar el score de riesgo TIM [...] I (Thrombolysis in Myocardial Infarction) en nuestra población. Se analizaron retrospectivamente pacientes con diagnóstico de SCA-SST. Se realizó seguimiento telefónico a los 6 meses del ingreso. Los puntos finales evaluados fueron la combinación de muerte, internación por síndrome coronario agudo y necesidad de revascularización. Se incluyeron 204 pacientes. El 70.2% eran hombres, edad promedio de 64.5 ± 11.8 años. Luego de la evaluación inicial, se hizo diagnóstico de angina inestable en el 34.6%, IM en 38.9% y el 26.4% fueron catalogados como "dolor no coronario". Al aplicar el score de TIMI, 52 (25.5%) pacientes tenían riesgo bajo, 106 (52%) riesgo intermedio, y 46 (22.5%) riesgo alto. La mortalidad global fue 12.6%. Se encontró un incremento progresivo y significativo en la tasa de eventos combinados a medida que aumentaba el score de TIMI (p Abstract in english Non-ST elevation acute coronary syndromes (NSTE-ACS) are frequent cause of hospitalization, being responsible for 10-15% of infarcts or deaths per year. The study was designed to analyze 6 months follow-up of cardiovascular events as well as to validate the Thrombolysis in Myocardial Infarction (TIM [...] I) risk score for patients hospitalized for NSTE-ACS. We retrospectively analyzed patients admitted with NSTE-ACS. Telephone follow-up were performed at 6 month. Combination of death, re-admission for acute coronary syndrome and revascularization were considered as end point. Two hundred and four patients were included for the analysis. There were 70.2% males, with a mean age of 64.5 ± 11.8 years. After the initial evaluation, we diagnosed unstable angina in 34.6% of cases, MI in 38.9% of cases, and 26.4% of patients were categorized as "non coronary chest pain". Applying the TIMI risk score, 52 (25.5%) patients had low risk, 106 (52%) intermediated risk, and 46 (22.5%) high risk. The global mortality was 12.3%. We found a progressively and significant increase in the rate of combined events as the TIMI score increase (p

  3. SCORE underestimates cardiovascular risk (CVR of HIV+ patients

    Directory of Open Access Journals (Sweden)

    R Ramírez

    2012-11-01

    Full Text Available The new European Guidelines of Dislipidemia Management of the European Societies of Cardiology and Arteriosclerosis consider HIV+ as patients at high risk of developing cardiovascular events and deaths. The objective of the study was to evaluate cardiovascular events and deaths in a series of HIV+ patients. Observational, cross-sectional study, including a cohort of HIV+ and HIV? patients from 2008. CVR was calculated using the SCORE-CVR chart. Variation on lipid profile and incidence of cardiovascular events, cardiovascular death or death related to any cause were recorded. Data was analyzed using SPSS version 20.0 for MAC. 154 HIV+ and 155 HIV? patients were included. Mean age: 44.8±9.5 vs 55.2±14.3 y and 69.5% vs 49% males respectively (p<0.01. Mean time since HIV+ diagnosis was 11±6.2 y. Mean BMI and systolic blood pressure were lower in HIV+ (25.1±6.7 kg/m2 vs 28.7±5.1 kg/m2, (p<0.01 and 119.6±19.4 vs 124.7±14.7 mmHg, (p=0.044; respectively. A lower proportion of hypertense, diabetic and obese patients was observed in HIV+ (25.5% vs 6.5%; 20.6% vs 3.9% and 36.8% vs 12.3% but a larger proportion of smokers (68.8% vs 29.7% was observed (p<0.01 in all cases. Mean cholesterol and LDLc were lower in HIV+ (191.2±41.4 vs 218.5±44.6 mg/dl and 109.5±33.9 vs 134.6±37.7 mg/dl; p<0.01; respectively but with a lower mean HDLc and higher TG (50.3±19 mg/dl vs 55.2±14.9 mg/dl; p=0.013 and 156.7±85.7 vs 135.8±66.2 mg/dl; p=0.017; respectively. There was no significant difference in mean CVR-SCORE (3.5±3.6% vs 4.4±3.8%; p=0.091. With this SCORE, 5.2±5.3 and 6.7±5.8 cardiovascular events or deaths should be expected in HIV+ and HIV? respectively at 10 y. Four years later cholesterol, LDLc, HDLc, TG in HIV+ and HIV? patients did not vary compared with those obtained 4 y before. 5 events and 1 death were seen at 4 y follow-up in HIV+, and in HIV? patients. The incidence of events in HIV+ patients is similar to the expected according to their SCORE at 10 y. We could suppose that once the 10 y follow-up is reached, this incidence would be higher. On the other side, in HIV? at 4 y just 3 events ocurred, far from the 6.7 events expected. There were no significant differences between lipid profiles in any of the cohorts. Lipid profile with low HDLc and high TG is persistent in HIV+ patients at 4 y follow-up. Understimation of CVR in HIV+ patients by SCORE charts could be present as soon as 4 y after the first assesment. This supports the stratification of HIV+ patients as high-risk patients in new guidelines.

  4. Assessment of cardiovascular risk in diabetes: Risk scores and provocative testing.

    Science.gov (United States)

    Lam, Teresa; Burns, Kharis; Dennis, Mark; Cheung, N Wah; Gunton, Jenny E

    2015-05-15

    Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with diabetes mellitus, who have a risk of cardiovascular mortality two to four times that of people without diabetes. An individualised approach to cardiovascular risk estimation and management is needed. Over the past decades, many risk scores have been developed to predict CVD. However, few have been externally validated in a diabetic population and limited studies have examined the impact of applying a prediction model in clinical practice. Currently, guidelines are focused on testing for CVD in symptomatic patients. Atypical symptoms or silent ischemia are more common in the diabetic population, and with additional markers of vascular disease such as erectile dysfunction and autonomic neuropathy, these guidelines can be difficult to interpret. We propose an algorithm incorporating cardiovascular risk scores in combination with typical and atypical signs and symptoms to alert clinicians to consider further investigation with provocative testing. The modalities for investigation of CVD are discussed. PMID:25987961

  5. Assessment of cardiovascular risk in diabetes: Risk scores and provocative testing

    Science.gov (United States)

    Lam, Teresa; Burns, Kharis; Dennis, Mark; Cheung, N Wah; Gunton, Jenny E

    2015-01-01

    Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with diabetes mellitus, who have a risk of cardiovascular mortality two to four times that of people without diabetes. An individualised approach to cardiovascular risk estimation and management is needed. Over the past decades, many risk scores have been developed to predict CVD. However, few have been externally validated in a diabetic population and limited studies have examined the impact of applying a prediction model in clinical practice. Currently, guidelines are focused on testing for CVD in symptomatic patients. Atypical symptoms or silent ischemia are more common in the diabetic population, and with additional markers of vascular disease such as erectile dysfunction and autonomic neuropathy, these guidelines can be difficult to interpret. We propose an algorithm incorporating cardiovascular risk scores in combination with typical and atypical signs and symptoms to alert clinicians to consider further investigation with provocative testing. The modalities for investigation of CVD are discussed. PMID:25987961

  6. Risk scores for diabetes and impaired glycaemia in the Middle East and North Africa

    DEFF Research Database (Denmark)

    Handlos, Line Neerup; Witte, Daniel Rinse

    2013-01-01

    AIMS: To develop risk scores for diabetes and diabetes or impaired glycaemia for individuals living in the Middle East and North Africa region. In addition, to derive national risk scores for Algeria, Saudi Arabia and the United Arab Emirates and to compare the performance of the regional risk scores with the national risk scores. METHODS: An opportunistic sample of 6588 individuals aged 30-75 years was screened. Screening consisted of a questionnaire and a clinical examination including measurement of HbA(1c). Two regional risk scores and national risk scores for each of the three countries were derived separately by stepwise backwards multiple logistic regression with diabetes [HbA(1c) ? 48 mmol/mol (? 6.5%)] and diabetes or impaired glycaemia [HbA(1c) ? 42 mmol/mol (? 6.0%)] as outcome. The performance of the regional and national risk scores was compared in data from each country by receiver operating characteristic analysis. RESULTS: The eight risk scores all included age and BMI, while additional variables differed between the scores. The areas under the receiver operating characteristic curves were between 0.67 and 0.70, and for sensitivities approximately 75%; specificities varied between 50% and 57%. The regional and the national risk scores performed equally well in the three national samples. CONCLUSIONS: Two regional risk scores for diabetes and diabetes or impaired glycaemia applicable to the Middle East and North Africa region were identified. The regional risk scores performed as well as the national risk scores derived in the same manner.

  7. Acute Myocardial Infarction in Young Adults: Study of Risk factors, Angiographic Features and Clinical Outcome

    Directory of Open Access Journals (Sweden)

    Rikesh Tamrakar

    2013-11-01

    Full Text Available Background and aims: Acute myocardial infarction below 45 years of age constitutes a specific subset of population having different risk factors and clinical features as compared to older patients. Pattern of coronary artery involvement and clinical outcome also varies suggesting different underlying pathophysiology. Better understanding this specific problem will lead to further improvement in management. Methods: One hundred and fifteen consecutive patients diagnosed as acute myocardial infarction and were below 45 years over the period of one year were enrolled in the study. Clinical parameters, risk factors, angiographic patterns were analysed. Patients were assessed daily during hospital stay to study in-hospital outcome and complications. Results: Out of total patients studied, 64.3% were smokers, 27.8% were hypertensive, 15.65% were diabetic and 9.6% had history of dyslipidemia. There was history of recreational drug abuse in 4.3% of patients. Most patients present as ST elevation myocardial infarction (87%. Majority of patients were in Killip class I (69.5% at presentation in emergency. Single vessel disease (58.3% was the most common finding in coronary angiography and 7.6% patients have normal or non obstructive coronary lesions. Complications include arrhythmia (6%, cardiogenic shock (5.2% and mortality (1.7%. Conclusions: In young acute myocardial infarction patients, smoking is the single most important modifiable risk factor. Other conventional risk factors are less strongly associated than older patients. Young patients tend to have less extensive coronary artery lesions. In few patients, presence of normal or non obstructive coronary lesions would suggest possibility of different mechanism of myocardial necrosis. Overall, these patients had favourable outcome and better prognosis.

  8. The Pakistan Risk of Myocardial Infarction Study: a resource for the study of genetic, lifestyle and other determinants of myocardial infarction in South Asia

    OpenAIRE

    Saleheen, Danish; Zaidi, Moazzam; Rasheed, Asif; Ahmad, Usman; Hakeem, Abdul; Murtaza, Muhammed; Kayani, Waleed; Faruqui, Azhar; Kundi, Assadullah; Zaman, Khan Shah; Yaqoob, Zia; Cheema, Liaquat Ali; Samad, Abdus; Rasheed, Syed Zahed; Mallick, Nadeem Hayat

    2009-01-01

    The burden of coronary heart disease (CHD) is increasing at a greater rate in South Asia than in any other region globally, but there is little direct evidence about its determinants. The Pakistan Risk of Myocardial Infarction Study (PROMIS) is an epidemiological resource to enable reliable study of genetic, lifestyle and other determinants of CHD in South Asia. By March 2009, PROMIS had recruited over 5,000 cases of first-ever confirmed acute myocardial infarction (MI) and over 5,000 matched...

  9. Individualized Risk of Surgical Complications: An Application of the Breast Reconstruction Risk Assessment Score

    Science.gov (United States)

    Mlodinow, Alexei S.; Khavanin, Nima; Hume, Keith M.; Simmons, Christopher J.; Weiss, Michael J.; Murphy, Robert X.; Gutowski, Karol A.

    2015-01-01

    Background: Risk discussion is a central tenet of the dialogue between surgeon and patient. Risk calculators have recently offered a new way to integrate evidence-based practice into the discussion of individualized patient risk and expectation management. Focusing on the comprehensive Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, we endeavored to add plastic surgical outcomes to the previously developed Breast Reconstruction Risk Assessment (BRA) score. Methods: The TOPS database from 2008 to 2011 was queried for patients undergoing breast reconstruction. Regression models were constructed for the following complications: seroma, dehiscence, surgical site infection (SSI), explantation, flap failure, reoperation, and overall complications. Results: Of 11,992 cases, 4439 met inclusion criteria. Overall complication rate was 15.9%, with rates of 3.4% for seroma, 4.0% for SSI, 6.1% for dehiscence, 3.7% for explantation, 7.0% for flap loss, and 6.4% for reoperation. Individualized risk models were developed with acceptable goodness of fit, accuracy, and internal validity. Distribution of overall complication risk was broad and asymmetric, meaning that the average risk was often a poor estimate of the risk for any given patient. These models were added to the previously developed open-access version of the risk calculator, available at http://www.BRAscore.org. Conclusions: Population-based measures of risk may not accurately reflect risk for many individual patients. In this era of increasing emphasis on evidence-based medicine, we have developed a breast reconstruction risk assessment calculator from the robust TOPS database. The BRA Score tool can aid in individualizing—and quantifying—risk to better inform surgical decision making and better manage patient expectations.

  10. Use of 123I-BMIPP single-photon emission tomography to estimate areas at risk following successful revascularization in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Previous studies have indicated that iodine-123 labelled ?-methyliodophenyl pentadecanoic acid (BMIPP), an iodinated fatty acid analogue, can identify persistent alteration of fatty acid metabolism after restoration of blood flow. To assess whether fatty acid imaging can delineate areas at risk following successful revascularization in patients with acute myocardial infarction (AMI), BMIPP findings at 1 week post AMI were compared with perfusion imaging before and after revascularization therapy. Sixty-five patients with AMI underwent technetium-99m tetrofosmin single-photon emission tomography (SPET) before m (TF0) and 1 week (TF1) after successful revascularization therapy. BMIPP SPET was also performed under a fasting state at 1 week (BM1) post AMI. The extent scores were calculated from the defect scores in 20 segments. The BM1 score (7.7±3.9) was similar to the TF0 score (8.8±4.2) (r=0.86, P<0.0001), but significantly higher than the TF1 score (5.8±3.9) (P<0.0001). A significant correlation was observed between the BM1 score and TF0 score (r=0.86, P<0.0001). Among a total of 1300 segments, the BM1 score was identical to the TF0 score in 1156 (88.9%). These data indicate that the ability of BMIPP imaging at 1 week post AMI to identify areas at risk is similar to that of tetrofosmin perfusion imaging in the acute phase. This may be due to the impairment of fatty acid uptake and metabolism reflecting prior severe ischaemic insult which persists at least 1 week ansult which persists at least 1 week after recovery of perfusion in the acute phase of AMI. (orig.)

  11. Statins reduce new-onset atrial fibrillation in a first-time myocardial infarction population : a nationwide propensity score-matched study

    DEFF Research Database (Denmark)

    Bang, Casper N; Gislason, Gunnar H

    2012-01-01

    Aim: To evaluate the effect of statins on reducing new-onset atrial fibrillation (AF) in a large real-world post-myocardial infarction (MI) population. Subsequently, to test if different statin doses, various types and compliance affected the incidence of new-onset AF post MI.Methods: All patients with first-time acute MI between 1997 and 2009 in Denmark and claimed prescriptions of statins after discharge were identified from the Danish nationwide administrative registers. Patients with a history of AF were excluded. Risk of new-onset AF according to statin use were analysed by multivariable time-dependent Cox regressions models adjusted for age, gender, year, concomitant medication, and comorbidity, and additionally in a propensity score-matched analysis.Results: A total of 89,703 patients with average follow up of 5.0 ± 3.5 years were included in this study. In the 56,044 patients receiving statins, 5698 (10%) had new-onset AF vs. 5010 (15%) in the 33,659 patients serving as controls. The adjusted Cox regression analysis showed significant reduction in new-onset AF (HR 0.83, 95% CI 0.80-0.87, p <0.001) in statin users. Adjustment for propensity score yielded nearly identical results (HR 0.82, 95% CI 0.78-0.85, p <0.001). Furthermore, patients compliant to statin treatment had significant reduction in new-onset AF (HR 0.84, 95% CI 0.80-0.87, p <0.001). Finally, simvastatin and atorvastatin were significantly more effective than pravastatin (both p <0.01) in reducing new-onset AF.Conclusions: Statin therapy was significantly associated with less new-onset AF in a nationwide cohort of post-MI patients. Furthermore, statins showed a type-dependent effect in preventing new-onset AF. These results support the beneficial effect of statin therapy beyond lipid lowering in patients with MI and underline the importance of statin adherence and choice of statin type.

  12. Awareness and use of cardiovascular risk scores by family physicians in southeastern Ontario

    Directory of Open Access Journals (Sweden)

    Murray F. Matangi

    2013-11-01

    Full Text Available Background: Our objective was to determine the assessment of cardiovascular risk by family physicians. Methods: A questionnaire was sent by mail or fax regarding both awareness and use of the various CV risk scores in southeastern Ontario. Results: Of 181 family physicians surveyed, 96% were aware of at least one CV risk score and 40% were aware of the JUPITER study. Despite this awareness, 72% simply counted risk factors to assess risk, rather than to calculate risk using established scoring methods. Only 23% used the JUPITER study criteria. This suggests an under-estimated of overall CV risk by family physician’s practicing in southeastern Ontario. Interpetation: Cardiovascular risk in primary care is being underestimated in southeastern Ontario. Additional knowledge translation strategies are required to enhance the family physician’s awareness and use of established risk scoring methods if we are to reduce the burden of CV disease.

  13. The development and validation of a risk score for predicting microalbuminuria in type 2 diabetic patients

    Directory of Open Access Journals (Sweden)

    Jayanton Patumanond

    2012-05-01

    Full Text Available Objective: To develop and validate a prognostic scoring scheme for the prediction of microalbuminuria in type 2 diabetic patients of Thai descent. Methods: The clinical information from type 2 diabetic patients who were treated at community hospitals was used to develop a prediction model (derivation set. The model evaluated at a tertiary hospital (validation set. A stepwise logistic regression model was used to identify the independent risk variables from the derivation set and a simple point scoring system was derived from the beta-coefficients. The risk scoring scheme was validated by the validation set. Results: The risk scoring scheme is based on six risk predictors: the duration of diabetes, age at the onset of diabetes, systolic blood pressure, low density lipoprotein levels, creatinine levels, and alcohol consumption. The total score ranged from 0 to 11.5. The likelihood of microalbuminuria in patients with low risk (scores ? 2 was 0.28, with moderate risk (scores 2.5 to 5.5 was 0.86, and high risk (scores ? 6 was 7.36. The area under the ROC curve of the derivation set and validation set were 0.768 (95% CI 0.73 - 0.81 and 0.758 (95% CI 0.70 - 0.80, respectively. Conclusion: Our scoring system is a simple and reasonably accurate method for predicting the future presence of microalbuminuria in type 2 diabetic patients.

  14. Poor predictive ability of the risk chart SCORE in a Danish population

    DEFF Research Database (Denmark)

    Saidj, Madina; JØrgensen, Torben

    2013-01-01

    In Denmark, the European risk chart Systematic COronary Risk Evaluation (SCORE) from the European Society of Cardiology is recommended for use in cardiovascular prevention. Nevertheless, its predictive ability in a Danish population has never been investigated. The purpose of this study was therefore to assess the predictive ability of the SCORE risk chart with regard to fatal cardiovascular risk according to the socio-demographic factors of age, sex, income and education in a Danish population.

  15. MODALITY OF DETERMINING THE TOTAL SCORE OF RISKS IN INTERNAL AUDIT

    Directory of Open Access Journals (Sweden)

    FRANCA DUMITRU

    2012-11-01

    Full Text Available Risk analysis materializes in: applying to the weightings of risk factors the level of risk assessment, on risk factors, based on the assessments made by auditors regarding: the functionality of internal control, the influence of quantitative and qualitative elements; determination of the total risk score, which represents a sum of weights between the appreciation level of each risk and the weightings of risk factors.

  16. Risk Stratification and Effects of the First 24-Hour Pharmacotherapy in Predominantly Hypertensive Patients with Acute Myocardial Infarction.

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Grünfeldová, H.; Monhart, Z.; Faltus, Václav; Tome?ková, Marie; Ryšavá, D.; Velimský, T.; Ballek, L.; Huba?, J.; Charalampidi, K.

    2009-01-01

    Ro?. 27, Suppl. 4 (2009), S421-S422. ISSN 0263-6352. [European Meeting on Hypertension /19./. 12.06.2009-16.06.2009, Milan] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : pilot registry of acute myocardial infarction * hypertension and other cardiovascular risk factors * first 24-hour pharmacotherapy of myocardial infarction Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  17. Usefulness of desirable lifestyle factors to attenuate the risk of heart failure among offspring whose parents had myocardial infarction before age 55 years.

    Science.gov (United States)

    Khawaja, Owais; Kotler, Gregory; Gaziano, John Michael; Djoussé, Luc

    2012-08-01

    Heart failure (HF) is one of the leading causes of hospitalization and death in the United States and throughout Europe. Although a higher risk for HF with antecedent myocardial infarction (MI) has been reported in offspring whose parents had MIs before age 55 years, it is unclear whether adherence to healthful behaviors can mitigate that risk. The aim of the present study was therefore to prospectively examine if adherence to healthy weight, regular exercise, moderate alcohol consumption, and abstinence from smoking can attenuate such increased HF risk. Information on parental history of MI and lifestyle factors was collected using questionnaires. Subjects adhering to ?3 healthy lifestyle factors were classified as having good versus poor lifestyle scores. Incident HF was assessed via yearly follow-up questionnaires and validated in a subsample. During an average follow up of 21.7 ± 6.5 years, 1,323 new HF cases (6.6%), of which 190 (14.4%) were preceded by MI, occurred. Compared to subjects with good lifestyle scores and no parental histories of premature MI, multivariate adjusted hazard ratios for incident HF with antecedent MI were 3.21 (95% confidence interval 1.74 to 5.91) for subjects with good lifestyle score and parental histories of premature MI, 1.52 (95% confidence interval 1.12 to 2.07) for those with poor lifestyle score and no parental histories of premature MI, and 4.60 (95% confidence interval 2.55 to 8.30) for those with poor lifestyle scores and parental histories of premature MI. In conclusion, our data suggest that even in subjects at higher risk for HF because of genetic predisposition, adherence to healthful lifestyle factors may attenuate such an elevated HF risk. PMID:22516528

  18. Comparison of visual scoring and quantitative planimetry methods for estimation of global infarct size on delayed enhanced cardiac MRI and validation with myocardial enzymes

    Energy Technology Data Exchange (ETDEWEB)

    Mewton, Nathan, E-mail: nmewton@gmail.com [Hopital Cardiovasculaire Louis Pradel, 28, Avenue Doyen Lepine, 69677 Bron cedex, Hospices Civils de Lyon (France); CREATIS-LRMN (Centre de Recherche et d' Applications en Traitement de l' Image et du Signal), Universite Claude Bernard Lyon 1, UMR CNRS 5220, U 630 INSERM (France); Revel, Didier [Hopital Cardiovasculaire Louis Pradel, 28, Avenue Doyen Lepine, 69677 Bron cedex, Hospices Civils de Lyon (France); CREATIS-LRMN (Centre de Recherche et d' Applications en Traitement de l' Image et du Signal), Universite Claude Bernard Lyon 1, UMR CNRS 5220, U 630 INSERM (France); Bonnefoy, Eric [Hopital Cardiovasculaire Louis Pradel, 28, Avenue Doyen Lepine, 69677 Bron cedex, Hospices Civils de Lyon (France); Ovize, Michel [Hopital Cardiovasculaire Louis Pradel, 28, Avenue Doyen Lepine, 69677 Bron cedex, Hospices Civils de Lyon (France); INSERM Unite 886 (France); Croisille, Pierre [Hopital Cardiovasculaire Louis Pradel, 28, Avenue Doyen Lepine, 69677 Bron cedex, Hospices Civils de Lyon (France); CREATIS-LRMN (Centre de Recherche et d' Applications en Traitement de l' Image et du Signal), Universite Claude Bernard Lyon 1, UMR CNRS 5220, U 630 INSERM (France)

    2011-04-15

    Purpose: Although delayed enhanced CMR has become a reference method for infarct size quantification, there is no ideal method to quantify total infarct size in a routine clinical practice. In a prospective study we compared the performance and post-processing time of a global visual scoring method to standard quantitative planimetry and we compared both methods to the peak values of myocardial biomarkers. Materials and methods: This study had local ethics committee approval; all patients gave written informed consent. One hundred and three patients admitted with reperfused AMI to our intensive care unit had a complete CMR study with gadolinium-contrast injection 4 {+-} 2 days after admission. A global visual score was defined on a 17-segment model and compared with the quantitative planimetric evaluation of hyperenhancement. The peak values of serum Troponin I (TnI) and creatine kinase (CK) release were measured in each patient. Results: The mean percentage of total left ventricular myocardium with hyperenhancement determined by the quantitative planimetry method was (20.1 {+-} 14.6) with a range of 1-68%. There was an excellent correlation between quantitative planimetry and visual global scoring for the hyperenhancement extent's measurement (r = 0.94; y = 1.093x + 0.87; SEE = 1.2; P < 0.001) The Bland-Altman plot showed a good concordance between the two approaches (mean of the differences = 1.9% with a standard deviation of 4.7). Mean post-processing time for quantitative planimetry was significantly longer than visual scoring post-processing time (23.7 {+-} 5.7 min vs 5.0 {+-} 1.1 min respectively, P < 0.001). Correlation between peak CK and quantitative planimetry was r = 0.82 (P < 0.001) and r = 0.83 (P < 0.001) with visual global scoring. Correlation between peak Troponin I and quantitative planimetry was r = 0.86 (P < 0.001) and r = 0.85 (P < 0.001) with visual global scoring. Conclusion: A visual approach based on a 17-segment model allows a rapid and accurate assessment of the myocardial global delayed enhancement. This scoring method could be used on a daily practice and useful for the management strategy of post-MI patients.

  19. Usefulness of residual ischemic myocardium within prior infarct zone for identifying patients at high risk late after acute myocardial infarction

    International Nuclear Information System (INIS)

    This study examines the prognostic implications of ischemia within the territory of a prior acute myocardial infarction (AMI) vs ischemia at a distance, which develops late after AMI. Sixty-one consecutive patients who underwent both exercise thallium-201 (TI-201) imaging and cardiac catheterization for evaluation of chest pain that developed after discharge from the hospital for AMI form the study group. Mean interval between infarction to the TI-201 study was 10 +/- 17 months. Initial and 2-hour delay TI-201 images were analyzed quantitatively to determine the presence and location (within vs outside the prior infarct zone) of TI-201 redistribution, a marker of ischemic viable myocardium. TI-201 imaging results were separated into 3 groups based on presence and location of TI-201 redistribution: no significant TI-201 redistribution was found in 16 patients; in 29, TI-201 redistribution was confined to the infarct zone; and in 16, TI-201 redistribution was outside the infarct zone. Stepwise multivariate logistic regression analysis was used to examine the comparative ability of TI-201 results and other patient variables to predict cardiac events. For total cardiac events (cardiac death, recurrent nonfatal AMI, unstable angina and coronary revascularization), both the presence of any TI-201 redistribution and multivessel angiographic coronary artery disease were significant predictors. However, when coronary revascularization was excluded as an endpoint, TI-201 redistwas excluded as an endpoint, TI-201 redistribution limited to the prior infarct zone was the only significant predictor of cardiac events. All 8 cardiac events occurred in patients with T1-201 redistribution limited to the infart zone

  20. Coronary angiographic findings in diagnostically manifested myocardial infarctions: Their relationship to psychlosocial and somatic risk factors

    International Nuclear Information System (INIS)

    The investigation was meant as an attempt to illustrate coronary arteriosclerosis as the cause of myocardial infarction and the mechanisms of its development as well as the conditions influencing it. The paper consists of two parts: 1) Literature part: In this part, risk factors of coronary arteriosclerosis and the mechanism of its effects (as far as known) are introduced. The results obtained by other authors are also summarized. 2) Empiric part: The following empiric part covers the author's own results which are discussed and compared to the results obtained by other authors. (orig./MG)

  1. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Lindhardsen, Jesper; Ahlehoff, Ole

    2011-01-01

    OBJECTIVES: /st> To examine in a nationwide cohort whether the risk of myocardial infarction (MI) in patients with rheumatoid arthritis (RA) is comparable to the risk in patients with diabetes mellitus (DM). METHODS: /st> The study included the entire Danish population followed from 1 January 1997 until 31 December 2006. Through individual level-linkage of nationwide administrative registers, the authors identified subjects who developed RA and DM. The risk of MI was analysed using multivariable Poisson regression models including data on cardioprotective drugs, comorbidity and socioeconomic status. RESULTS: /st> From a total of 4 311 022 individuals included in the cohort, 10 477 and 130 215 individuals developed RA and DM respectively. The overall incidence rate ratio (IRR) of MI in RA was 1.7 (95% CI 1.5 to 1.9), which was similar to the risk in DM (1.7 (1.6 to 1.8); p=0.64 for difference). The risk was significantly increased in all groups when stratifying on age and gender, with higher RRs in younger patients. This was especially pronounced in women RA is associated with the same risk of MI as DM, and the risk of MI in RA patients generally corresponded to the risk in non-RA subjects 10 years older.

  2. Comparison of carotid artery intima - media thickness and risk factors of atherosclerosis in lacunar versus non-lacunar cerebral infarcts

    Directory of Open Access Journals (Sweden)

    Seyed Ali Mousavi

    2007-07-01

    Full Text Available

    BACKGROUND: Increases in the thickness of the intima-media of the carotid artery have been associated with an increased risk of myocardial infarction and stroke in subjects without a history of cardiovascular disease. Lacunar infarcts, one of the most common subtypes of ischemic stroke, show unique pathological and clinicoradiological characteristics. The present study examined the relationship between the vascular risk factors, including carotid artery intimamedia thickness (IMT, and lacunar versus non-lacunar infarcts.
    METHODS: We collected data from patients admitted to hospital with acute ischemic stroke. 195 Patients and 96 control subjects underwent B-mode ultrasonographic measurements of IMT of the common carotid artery. We examined the association of lacunar and non-lacunar infarcts with age, sex, and potential vascular risk factors.
    RESULTS: Of 195 adult patients with acute ischemic stroke, 87 were considered lacunar and 108 were considered nonlacunar strokes. Between these two groups of patients, we did not find a significantly different percentage of diabetes,
    smoking, hypertension, dyslipidemia, myocardial infarction, or previous history of ischemic stroke, alcohol, obesity,
    atherogen diet, exercise, and IMT. However, patients with lacunar infarct, diabetes mellitus (P = 0.02, and hypertension
    (P = 0.02 had a significantly higher percentage of history of prior CVA (P = 0.03 and a significantly higher percentage
    of non-lacunar infarct.
    CONCLUSIONS: The present results indicated that diabetes mellitus and hypertension are more common in patients with lacunar infarcts, and history of CVA is more common in patients with non–lacunar infarcts. We further concluded that IMT cannot differentiate subtypes of ischemic stroke. Because risk factors and clinical presentation of ischemic stroke differ among races, more national studies should be done in our country to find ways to prevent stroke and its complications.
    KEY WORDS: Lacunar infarction, risk factors, ultrasonography.

  3. New risk scoring system for femoral pseudoaneurysm formation after cardiac catheterization (Ate? Scoring System)

    OpenAIRE

    Ate?, Mehmet; AKPINAR, Mehmet Be?ir; OKUR, Faik Fevzi; ABACILAR, Ahmet Feyzi; ?AHIN, Veysel; UYAR, ?hsan Sami; Alayunt, Emin Alp

    2013-01-01

    To create a new scoring system for femoral pseudoaneurysm (FPA) formation after diagnostic or interventional cardiac catheterization. Materials and methods: We evaluated 41,322 transfemoral catheterization procedures performed in our center within 7 years. Among all procedures, 630 FPAs developed that required surgical repair. Eighty-five cases were managed by compression with duplex guidance. As a case-control group, 1260 patients were selected from the patients who had been catheterized d...

  4. DESIGN AND STUDY OF ONLINE FUZZY RISK SCORE ANALYZER FOR DIABETES MELLITUS

    Directory of Open Access Journals (Sweden)

    SunithaKarnam Anantha

    2013-01-01

    Full Text Available The aim of this study is to determine the risks of various subjects to type 2 Diabetes and its dependence on the different subject records. A Fuzzy based system was designed to find the risk scores for diabetes based on risk score derived from Chennai Urban Rural Epidemiology Study (CURES. The risk score that has been adapted into the system is referred to as Indian Diabetes Risk Score (IDRS. The variables employed in it are age, gender, waist, exercise and history of diabetes. A database of subject records was collected from hundred random individuals from southern regions of India. A comparative study was performed on these records between the normal and fuzzified risk score based on IDRS. The program has been designed using Lab VIEW with Fuzzy System Designer being used for fuzzy rule execution. The details are transmitted online through web page to the physicians who can provide assistance in prevention of diabetes. The obtained risk scores of the subjects are used to improve the lifestyle and delay the onset of diabetes to the maximum possible. This system can be implemented in rural regions where experienced medical assistance may not be available. This system would form an ideal part of the current developments in medicine where physical physician presence is not required due to the buttress provided by advancements in computer technology. The aim of this study is to determine the risks of various subjects to type 2 Diabetes and its dependence on the different subject records. A Fuzzy based system was designed to find the risk scores for diabetes based on risk score derived from Chennai Urban Rural Epidemiology Study (CURES. The risk score that has been adapted into the system is referred to as Indian Diabetes Risk Score (IDRS. The variables employed in it are age, gender, waist, exercise and history of diabetes. A database of subject records was collected from hundred random individuals from southern regions of India. A comparative study was performed on these records between the normal and fuzzified risk score based on IDRS. The program has been designed using Lab VIEW with Fuzzy System Designer being used for fuzzy rule execution. The details are transmitted online through web page to the physicians who can provide assistance in prevention of diabetes. The obtained risk scores of the subjects are used to improve the lifestyle and delay the onset of diabetes to the maximum possible. This system can be implemented in rural regions where experienced medical assistance may not be available. This system would form an ideal part of the current developments in medicine where physical physician presence is not required due to the buttress provided by advancements in computer technology.

  5. Predicting stroke through genetic risk functions: The CHARGE risk score project

    Science.gov (United States)

    Ibrahim-Verbaas, Carla A; Fornage, Myriam; Bis, Joshua C; Choi, Seung Hoan; Psaty, Bruce M; Meigs, James B; Rao, Madhu; Nalls, Mike; Fontes, Joao D; O’Donnell, Christopher J.; Kathiresan, Sekar; Ehret, Georg B.; Fox, Caroline S; Malik, Rainer; Dichgans, Martin; Schmidt, Helena; Lahti, Jari; Heckbert, Susan R; Lumley, Thomas; Rice, Kenneth; Rotter, Jerome I; Taylor, Kent D; Folsom, Aaron R; Boerwinkle, Eric; Rosamond, Wayne D; Shahar, Eyal; Gottesman, Rebecca F.; Koudstaal, Peter J; Amin, Najaf; Wieberdink, Renske G.; Dehghan, Abbas; Hofman, Albert; Uitterlinden, André G; DeStefano, Anita L.; Debette, Stephanie; Xue, Luting; Beiser, Alexa; Wolf, Philip A.; DeCarli, Charles; Ikram, M. Arfan; Seshadri, Sudha; Mosley, Thomas H; Longstreth, WT; van Duijn, Cornelia M; Launer, Lenore J

    2014-01-01

    Background and Purpose Beyond the Framingham Stroke Risk Score (FSRS), prediction of future stroke may improve with a genetic risk score (GRS) based on Single nucleotide polymorphisms (SNPs) associated with stroke and its risk factors. Methods The study includes four population-based cohorts with 2,047 first incident strokes from 22,720 initially stroke-free European origin participants aged 55 years and older, who were followed for up to 20 years. GRS were constructed with 324 SNPs implicated in stroke and 9 risk factors. The association of the GRS to first incident stroke was tested using Cox regression; the GRS predictive properties were assessed with Area under the curve (AUC) statistics comparing the GRS to age sex, and FSRS models, and with reclassification statistics. These analyses were performed per cohort and in a meta-analysis of pooled data. Replication was sought in a case-control study of ischemic stroke (IS). Results In the meta-analysis, adding the GRS to the FSRS, age and sex model resulted in a significant improvement in discrimination (All stroke: ?joint AUC =0.016, p-value=2.3*10-6; IS: ? joint AUC =0.021, p-value=3.7*10?7), although the overall AUC remained low. In all studies there was a highly significantly improved net reclassification index (p-values <10?4). Conclusions The SNPs associated with stroke and its risk factors result only in a small improvement in prediction of future stroke compared to the classical epidemiological risk factors for stroke. PMID:24436238

  6. Impact of antidepressants use on risk of myocardial infarction: A systematic review and meta-analysis

    Science.gov (United States)

    Undela, Krishna; Parthasarathi, Gurumurthy; John, Sharon Sunny

    2015-01-01

    Aims: The aim of the study was to perform a systematic review and meta-analysis to determine the association between antidepressants use and risk of myocardial infarction (MI), and whether this association differs between tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). Methods: A PubMed/MEDLINE search was conducted for studies published up to December 2013. Included studies were evaluated for publication bias and heterogeneity. Depending on the presence of heterogeneity, a random or fixed effects model was used to identify the pooled relative risk (RR) with 95% confidence intervals (CIs). Cumulative meta-analysis, subgroup and sensitivity analyses were also performed. All analyses were performed using comprehensive meta-analysis software. Results: Fourteen (five cohort and nine case–control) studies were included. There was heterogeneity among the studies (Pheterogeneity = 0.02; I2 = 68%) but no publication bias (Begg's P = 0.30 and Egger's P = 0.45). Antidepressants use significantly increases the risk of myocardial infarction (MI) (RR = 2.03; 95% CI = 1.30–3.18; P < 0.01). On subgroup analysis by study design, cohort studies show significant positive association (RR = 2.16; 95% CI = 1.42–3.29; P < 0.01), but not case–control studies (RR = 2.47; 95% CI = 0.69–8.90; P = 0.17). Sensitivity analysis and cumulative meta-analysis confirmed the stability of results. TCAs users are having 36% increased risk of MI after excluding one outlier (RR = 1.36; 95% CI = 1.10–1.67; P < 0.01), but SSRIs showing no association (RR = 0.84; 95% CI = 0.57–1.22; P = 0.35). Conclusions: We found evidence that the use of antidepressants was associated with elevated risk of MI. Further research is needed to identify the underlying biological mechanisms.

  7. Low Apgar Scores and Risk of Childhood Attention Deficit Hyperactivity Disorder

    DEFF Research Database (Denmark)

    Li, Jiong; Olsen, JØrn

    2011-01-01

    OBJECTIVE: To examine whether low Apgar scores at 5 minutes are associated with increased risks of attention deficit hyperactivity disorder (ADHD). STUDY DESIGN: We conducted a nationwide population-based cohort study of all 980 902 singletons born in Denmark from 1988 to 2001. All children were monitored from 3 years of age until a first International Classification of Diseases diagnosis of hyperkinetic disorder, a first medication for ADHD, migration, death, or the end of 2006, whichever came first. We used Cox regression models to examine the association between Apgar scores at 5 minutes and ADHD. RESULTS: Apgar scores were inversely associated with risk of ADHD (hazard ratio 0.92; 95% confidence interval [CI]: 0.88-0.96, P trend <.001). Compared with children with Apgar scores of 9 or 10 at 5 minutes, the risk for ADHD was 75% higher in children with Apgar scores of 1 to 4 (hazard ratio 1.75; 95% CI: 1.15-2.11) and 63% higher for those with Apgar scores of 5 to 6 (95% CI: 1.25-2.11). CONCLUSIONS: A low Apgar score was associated with an increased risk of ADHD in childhood. Low Apgar scores and ADHD may share common causes or a low Apgar score reflects at least one causal pathway leading to ADHD.

  8. Dual radionuclide single-photon emission computed tomography in the prediction of further ischemic risk after acute myocardial infarction

    International Nuclear Information System (INIS)

    To evaluate whether the findings of dual single-photon emission computed tomography (SPECT) with technetium-99m pyrophosphate (Tc-99m PPi) and thallium-201 were predictive of further cardiac events in their hospital course, we studied 130 patients recovering from acute myocardial infarction (AMI). Fifty-four patients showed overlapping of Tc-99m PPi and thallium-201 in the same location (overlap positive group), and 76 patients had no overlap (overlap negative group). Of the 130 patients, 36 (28%) had a cardiac event. In patients in the overlap positive group, the incidence of subsequent events was significantly higher than in patients in the overlap negative group (44% versus 16%; p<0.001). In the overlap positive group, the Tc-99m PPi uptake score and the number of overlap segments in patients with further events was significantly higher than those in patients without further events (10.2±5.1 versus 6.4±4.1, p<0.005 and 5.2±2.0 versus 3.3±1.3, p<0.001, respectively). These results suggest that patients who have a Tc-99m PPi and thallium-201 overlap negative scan can be candidates for early hospital discharge. In contrast, patients who have a greater number of overlap segments may require early catheterization and revascularization, so that simultaneous SPECT imaging Tc-99m PPi and thallium-201 might be useful for identifying patients with further ischemic risk after AMI in their hospital course. (author)

  9. Dual radionuclide single-photon emission computed tomography in the prediction of further ischemic risk after acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Isoda, Hiroyoshi; Itagaki, Yasushi; Nomura, Noriyuki [Fujieda Municipal Hospital, Shizuoka (Japan)] [and others

    1998-08-01

    To evaluate whether the findings of dual single-photon emission computed tomography (SPECT) with technetium-99m pyrophosphate (Tc-99m PPi) and thallium-201 were predictive of further cardiac events in their hospital course, we studied 130 patients recovering from acute myocardial infarction (AMI). Fifty-four patients showed overlapping of Tc-99m PPi and thallium-201 in the same location (overlap positive group), and 76 patients had no overlap (overlap negative group). Of the 130 patients, 36 (28%) had a cardiac event. In patients in the overlap positive group, the incidence of subsequent events was significantly higher than in patients in the overlap negative group (44% versus 16%; p<0.001). In the overlap positive group, the Tc-99m PPi uptake score and the number of overlap segments in patients with further events was significantly higher than those in patients without further events (10.2{+-}5.1 versus 6.4{+-}4.1, p<0.005 and 5.2{+-}2.0 versus 3.3{+-}1.3, p<0.001, respectively). These results suggest that patients who have a Tc-99m PPi and thallium-201 overlap negative scan can be candidates for early hospital discharge. In contrast, patients who have a greater number of overlap segments may require early catheterization and revascularization, so that simultaneous SPECT imaging Tc-99m PPi and thallium-201 might be useful for identifying patients with further ischemic risk after AMI in their hospital course. (author)

  10. A Statistical Study of Socio-economic and Physical Risk Factors of Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    M. Alamgir

    2005-07-01

    Full Text Available A sample of 506 patients from various hospitals in Peshawar was examined to determine significant socio-economic and physical risk factors of Myocardial Infarction (heart attack. The factors examined were smoking (S, hypertension (H, cholesterol (C, diabetes (D, family history (F, residence (R, own a house (OH, number of dependents (ND, household income (I, obesity and lack of exercise (E. The response variable MI was binary. Therefore, logistic regression was applied (using GLIM and SPSS packages to analyze the data and to select a parsimonious model. Logistic regression models have been obtained indicating significant risk factors for both sexes, for males and for females separately. The best-selected model for both sexes is of factors S, F, D, H and C. The best-selected model for males is of factors CIFH, S, H, D, C and F, while the best-selected model for females is of factors D, H, C and F.

  11. Psoriasis and the Framingham risk score in a Danish hospital cohort

    DEFF Research Database (Denmark)

    GyldenlØve, Mette; Jensen, Peter

    2014-01-01

    Psoriasis is a chronic inflammatory skin disease, which is associated with an increased risk of cardiovascular morbidity and mortality. Our aim was to compare the Framingham risk score, a method to estimate coronary heart disease and prevalences of cardiovascular risk factors in patients with psoriasis and the general population.

  12. Elevated triglycerides and risk of myocardial infarction in HIV-positive persons

    DEFF Research Database (Denmark)

    Worm, Signe W; Kamara, David Alim

    2011-01-01

    Objectives: To explore the relationship between elevated triglyceride levels and the risk of myocardial infarction (MI) in HIV-positive persons after adjustment for total cholesterol (TC), high-density lipoprotein–cholesterol (HDL-C) and nonlipid risk factors. Background: Although elevated triglyceride levels are commonly noted in HIV-positive individuals, it is unclear whether they represent an independent risk factor for MI. Methods: The incidence of MI during follow-up was stratified according to the latest triglyceride level. Multivariable Poisson regression models were used to describe the independent association between the latest triglyceride level and MI risk after adjusting for TC and HDL-C, nonlipids cardiovascular disease (CVD) risk factors, HIV and treatment-related factors. Results: The 33 308 persons included in the study from 1999 to 2008 experienced 580 MIs over 178 835 person-years. Unadjusted, the risk of MI increased by 67% [relative risk (RR) 1.67, 95% confidence interval 1.54–1.80] per doubling in triglyceride level. After adjustment for the latest TC and HDL-C level, the RR dropped to 1.33 (95% confidence interval 1.21–1.45); this effect was further attenuated by other CVD risk factors and the RR was reduced to 1.17 (95% confidence interval 1.06–1.29). In models that additionally adjusted for HIV and treatment factors, the risk was further diminished, although remained significant (RR 1.11, 95% confidence interval 1.01–1.23). Conclusion: Higher triglyceride levels were marginally independently associated with an increased risk of MI in HIV-positive persons, although the extent of reduction in RR after taking account of latest TC, latest HDL-C and other confounders suggests that any independent effect is small.

  13. Risk factors for myocardial infarction with normal coronary arteries and myocarditis compared with myocardial infarction with coronary artery stenosis.

    Science.gov (United States)

    Agewall, Stefan; Daniel, M; Eurenius, L; Ekenbäck, C; Skeppholm, M; Malmqvist, K; Hofman-Bang, C; Collste, O; Frick, M; Henareh, L; Jernberg, T; Tornvall, P

    2012-10-01

    The interest and awareness of myocardial infarction with normal coronary arteries (MINCA) have increased recently due to the frequent use of coronary angiography, the description of Takotsubo stress cardiomyopathy, and new sensitive troponin analyses. The prevalence of MINCA in all patients with myocardial infarction (MI) was registered during a 3-month period in the Stockholm metropolitan area in Sweden. The results showed that MINCA is more common than previously thought (7%) and affecting one third of every woman with MI. Patients with myocarditis were younger and more often presented with signs of inflammation such as elevated C-reactive protein and fever. Myocarditis constitutes an important differential diagnosis for coronary artery disease. There is a need for larger studies of MINCA, including investigation with cardiac magnetic resonance imaging, to establish prevalence and pathological process in this important subgroup of MI. PMID:22210737

  14. A Simple Risk Score for Identifying Individuals with Impaired Fasting Glucose in the Southern Chinese Population

    Directory of Open Access Journals (Sweden)

    Hui Wang

    2015-01-01

    Full Text Available This study aimed to develop and validate a simple risk score for detecting individuals with impaired fasting glucose (IFG among the Southern Chinese population. A sample of participants aged ?20 years and without known diabetes from the 2006–2007 Guangzhou diabetes cross-sectional survey was used to develop separate risk scores for men and women. The participants completed a self-administered structured questionnaire and underwent simple clinical measurements. The risk scores were developed by multiple logistic regression analysis. External validation was performed based on three other studies: the 2007 Zhuhai rural population-based study, the 2008–2010 Guangzhou diabetes cross-sectional study and the 2007 Tibet population-based study. Performance of the scores was measured with the Hosmer-Lemeshow goodness-of-fit test and ROC c-statistic. Age, waist circumference, body mass index and family history of diabetes were included in the risk score for both men and women, with the additional factor of hypertension for men. The ROC c-statistic was 0.70 for both men and women in the derivation samples. Risk scores of ?28 for men and ?18 for women showed respective sensitivity, specificity, positive predictive value and negative predictive value of 56.6%, 71.7%, 13.0% and 96.0% for men and 68.7%, 60.2%, 11% and 96.0% for women in the derivation population. The scores performed comparably with the Zhuhai rural sample and the 2008–2010 Guangzhou urban samples but poorly in the Tibet sample. The performance of pre-existing USA, Shanghai, and Chengdu risk scores was poorer in our population than in their original study populations. The results suggest that the developed simple IFG risk scores can be generalized in Guangzhou city and nearby rural regions and may help primary health care workers to identify individuals with IFG in their practice.

  15. A Study of Risk Factors and T- Score Variability in Romanian Women with Postmenopausal Osteoporosis

    Science.gov (United States)

    TöRöK-OANCE, Rodica

    2013-01-01

    Abstract Background The purpose of this study was to analyse the prevalence of postmenopausal osteoporosis risk factors and to analyse the T-score variability in spine and hip according to the associated risk factors. Methods This is a retrospective study (2003-2007) including 177 female patients with postmenopausal osteoporosis. The patients were separated in seven groups according to the number of risk factors per case. The T-score was compared between this groups using unpaired t-Student test. Results The most frequent risk factor was early menopause (44.63%), followed by low consumption of dairy products (37.29%), coffee consumption (25.99%), sedentary lifestyle (20.9%), smoking (19.21%), delayed menarche (15.25%), low body mass index (10.71%), nulliparity (7.91%), alcohol consumption (0.56%). The maximum number of risk factors per case was six. The T-score decreased with increasing number of risk factors. T-score differences are statistically significant when comparing cases with 6 risk factors to cases with 5 risk factors (P=0.0315 in spine; P=0.0088 in hip), 4 risk factors (P=0.0076 in spine; P=0.043 in hip), 3 risk factors (Posteoporosis risk factors, followed by adopting an appropriate lifestyle and diet.

  16. Estimating Risk of Alcohol Dependence Using Alcohol Screening Scores*

    OpenAIRE

    Rubinsky, Anna D.; Kivlahan, Daniel R.; Volk, Robert J.; Maynard, Charles; Bradley, Katharine A.

    2009-01-01

    Brief alcohol counseling interventions can reduce alcohol consumption and related morbidity among non-dependent risky drinkers, but more intensive alcohol treatment is recommended for persons with alcohol dependence. This study evaluated whether scores on common alcohol screening tests could identify patients likely to have current alcohol dependence so that more appropriate follow-up assessment and/or intervention could be offered. This cross-sectional study used secondary data from 392 male...

  17. Exome sequencing identifies rare LDLR and APOA5 alleles conferring risk for myocardial infarction

    DEFF Research Database (Denmark)

    Do, Ron; Stitziel, Nathan O

    2015-01-01

    Myocardial infarction (MI), a leading cause of death around the world, displays a complex pattern of inheritance. When MI occurs early in life, genetic inheritance is a major component to risk. Previously, rare mutations in low-density lipoprotein (LDL) genes have been shown to contribute to MI risk in individual families, whereas common variants at more than 45 loci have been associated with MI risk in the population. Here we evaluate how rare mutations contribute to early-onset MI risk in the population. We sequenced the protein-coding regions of 9,793 genomes from patients with MI at an early age (?50 years in males and ?60 years in females) along with MI-free controls. We identified two genes in which rare coding-sequence mutations were more frequent in MI cases versus controls at exome-wide significance. At low-density lipoprotein receptor (LDLR), carriers of rare non-synonymous mutations were at 4.2-fold increased risk for MI; carriers of null alleles at LDLR were at even higher risk (13-fold difference). Approximately 2% of early MI cases harbour a rare, damaging mutation in LDLR; this estimate is similar to one made more than 40 years ago using an analysis of total cholesterol. Among controls, about 1 in 217 carried an LDLR coding-sequence mutation and had plasma LDL cholesterol > 190 mg dl(-1). At apolipoprotein A-V (APOA5), carriers of rare non-synonymous mutations were at 2.2-fold increased risk for MI. When compared with non-carriers, LDLR mutation carriers had higher plasma LDL cholesterol, whereas APOA5 mutation carriers had higher plasma triglycerides. Recent evidence has connected MI risk with coding-sequence mutations at two genes functionally related to APOA5, namely lipoprotein lipase and apolipoprotein C-III (refs 18, 19). Combined, these observations suggest that, as well as LDL cholesterol, disordered metabolism of triglyceride-rich lipoproteins contributes to MI risk.

  18. Prothrombotic gene variants as risk factors of acute myocardial infarction in young women

    Directory of Open Access Journals (Sweden)

    Tomaiuolo Rossella

    2012-11-01

    Full Text Available Abstract Background Acute myocardial infarction (AMI in young women represent an extreme phenotype associated with a higher mortality compared with similarly aged men. Prothrombotic gene variants could play a role as risk factors for AMI at young age. Methods We studied Factor V Leiden, FII G20210A, MTHFR C677T and beta-fibrinogen -455G>A variants by real-time PCR in 955 young AMI (362 females and in 698 AMI (245 females patients. The data were compared to those obtained in 909 unrelated subjects (458 females from the general population of the same geographical area (southern Italy. Results In young AMI females, the allelic frequency of either FV Leiden and of FII G20210A was significantly higher versus the general population (O.R.: 3.67 for FV Leiden and O.R.: 3.84 for FII G20210A; p Discussion and conclusion Our data confirm that young AMI in females is a peculiar phenotype with specific risk factors as the increased plasma procoagulant activity of FV and FII. On the contrary, the homozygous state for the 677T MTHFR variant may cause increased levels of homocysteine and/or an altered folate status and thus an increased risk for AMI, particularly in males. The knowledge of such risk factors (that may be easily identified by molecular analysis may help to improve prevention strategies for acute coronary diseases in specific risk-group subjects.

  19. Are the myocardial infarction risk factors the same in survived and dead patients

    International Nuclear Information System (INIS)

    Coronary heart disease is one of the most common diseases causing mortality and morbidity in industrialized and developing countries. The first presentation in 25% of cases is sudden cardiac death. The most common risk factors in dead people are hypercholesterolemia. This study was carried out to compare the prevalence of risk factors in patients hospitalized in CCU's and cardiology departments (case group) and people who died because of sudden death myocardial infarction before arriving at hospitals (control group). This study was a case-control one, carried out on 154 patients and 112 dead persons. The questionnaires were completed after referring to their first relatives and the documents, in control group and in case group, were completed from patients and their records in hospitals. Then history of risk factor were compared. The ratio of men/women in the first group (hospitalized patients) was 3 and the second group (dead patients) were 1.7 (P=0.000). The peak ages in men of both groups were 60 to 69 years old, 2-3 times more than women in both groups. The most prevalent risk factor in women of both groups was hypertension, the same as in men of the control group. But the most prevalent risk factor in men of the case group was smoking (P=0.000). So, primary prevention which has a great role in controlling coronary artery disease is suggested

  20. Posttraumatic stress and myocardial infarction risk perceptions in hospitalized acute coronary syndrome patients

    Directory of Open Access Journals (Sweden)

    DonaldEdmondson

    2012-05-01

    Full Text Available Posttraumatic stress disorder (PTSD is related to acute coronary syndrome (ACS; i.e., myocardial infarction or unstable angina recurrence and poor post-ACS adherence to medical advice. Since risk perceptions are a primary motivator of adherence behaviors, we assessed the relationship of probable PTSD to ACS risk perceptions in hospitalized ACS patients (n= 420. Participants completed a brief PTSD screen 3-7 days post-ACS, and rated their 1-year ACS recurrence risk relative to other men or women their age. Most participants exhibited optimistic bias (mean recurrence risk estimate between “average” and “below average”. Further, participants who screened positive for current PTSD (n=15 showed significantly greater optimistic bias than those who screened negative (p< .05, after adjustment for demographics, ACS severity, medical comorbidities, depression, and self-confidence in their ability to control their heart disease. Clinicians should be aware that psychosocial factors, and PTSD in particular, may be associated with poor adherence to medical advice due to exaggerated optimistic bias in recurrence risk perceptions.

  1. Attributable risks for acute myocardial infarction in four countries of Latin America.

    Science.gov (United States)

    Ciruzzi, Mario; Schargrodsky, Herman; Pramparo, Palmira; Rivas Estany, Eduardo; Rodriguez Naude, Lidia; de la Noval Garcia, Reynaldo; Gaxiola Cazarez, Samuel; Meaney, Eduardo; Nass, Alecia; Finizola, Bartolome; Castillo, Luis

    2003-01-01

    This multicenter case control study investigated, in four countries of America, the proportions of acute myocardial infarction (AMI) attributable to cholesterol, smoking, hypertension, body mass index, diabetes and family history of coronary heart disease (attributable risks, AR). AR were estimated using information from 1060 cases of AMI and 1071 controls from Argentina, 323 cases of AMI and 314 controls from Cuba, 200 cases of AMI and 200 controls from Mexico and 266 cases of AMI and 264 controls from Venezuela. AR were obtained from the prevalence of coronary risk factors in the cases and the corresponding Odds Ratio (OR) derived through appropriate multivariate models. The AR for AMI observed for hypercholesterolaemia were the following: Venezuela 27%, Mexico 3%, Cuba 30% and Argentina 36%; for diabetes: Venezuela 10%, Mexico 15%, Cuba 5% and Argentina 7% and for body mass Index: Venezuela 12%, Mexico 3%, Cuba 19% and Argentina 17%. The same risk factor may have a different attributable risk in different populations. Together, hypercholesterolaemia, hypertension, smoking, diabetes, body mass index and family history of coronary heart disease accounted for 76% of all cases of AMI in Venezuela, 70% in Mexico, 81% in Cuba and 79% in Argentina. The knowledge of attributable risks could have important implications for public health strategies, especially in those countries with limited health care resources. PMID:14719311

  2. A risk score for predicting mortality in patients with asymptomatic mild to moderate aortic stenosis

    DEFF Research Database (Denmark)

    Holme, Ingar; Pedersen, Terje R

    2012-01-01

    BackgroundPrognostic information for asymptomatic patients with aortic stenosis (AS) from prospective studies is scarce and there is no risk score available to assess mortality.ObjectivesTo develop an easily calculable score, from which clinicians could stratify patients into high and lower risk of mortality, using data from the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study.MethodA search for significant prognostic factors (p

  3. Screening Performance of Diabetes Risk Scores Among Asians and Whites in Rural Kerala, India

    OpenAIRE

    Sathish, Thirunavukkarasu; Kannan, Srinivasan; Sarma, Sankara P.; Thankappan, Kavumpurathu Raman

    2013-01-01

    We compared the screening performance of risk scores for Asians and whites for diabetes, dysglycemia, and metabolic syndrome. Our subjects were 451 people aged 15 to 64 years who participated in a cohort study from May 2003 through September 2010 in a rural area of the Thiruvananthapuram district of Kerala, India. All outcome measures showed overlap in the range of area under the receiver operating characteristic curves of Asian and white diabetes risk scores (DRSs). Asian and white DRSs perf...

  4. Assessing Framingham cardiovascular risk scores in subjects with diabetes and their correlation with diabetic retinopathy

    Directory of Open Access Journals (Sweden)

    Deepali R Damkondwar

    2012-01-01

    Full Text Available Aim: To study the Framingham cardiovascular risk assessment scores in subjects with diabetes and their association with diabetic retinopathy in subjects with diabetes. Materials and Methods: In this population-based prospective study, subjects with diabetes were recruited (n=1248; age ?40 years. The Framingham cardiovascular risk scores were calculated for 1248 subjects with type 2 diabetes. The scores were classified as high risk (>10%, and low risk (<10%. Results: Out of the 1248 subjects, 830 (66.5% patients had a low risk of developing cardiovascular disease (CVD in 10 years and 418 (33.5% had a high risk of developing CVD in 10 years. The risk of developing CVD was more in males than females (56.8% vs. 7% The prevalence of both diabetic retinopathy and sight-threatening retinopathy was more in the high-risk group (21% and 4.5%, respectively. The risk factors for developing diabetic retinopathy were similar in both the groups (low vs. high - duration of diabetes (OR 1.14 vs. 1.08, higher HbA1c (OR 1.24 vs. 1.22, presence of macro- and microalbuminuria (OR 10.17 vs. 6.12 for macro-albuminuria and use of insulin (OR 2.06 vs. 4.38. The additional risk factors in the high-risk group were presence of anemia (OR 2.65 and higher serum high density lipoprotein (HDL cholesterol (OR 1.05. Conclusion: Framingham risk scoring, a global risk assessment tool to predict the 10-year risk of developing CVD, can also predict the occurrence and type of diabetic retinopathy. Those patients with high CVD scores should be followed up more frequently and treated adequately. This also warrants good interaction between the treating physician/cardiologist and the ophthalmologist.

  5. The effect of sample age and prediction resolution on myocardial infarction risk prediction.

    Science.gov (United States)

    Tay, Darwin; Poh, Chueh Loo; Van Reeth, Eric; Kitney, Richard I

    2015-05-01

    Myocardial infarction (MI) is one of the leading causes of death in many developed countries. Hence, early detection of MI events is critical for effective preventative therapies, potentially reducing avoidable mortality. One approach for early disease prediction is the use of risk prediction models developed using machine learning techniques. One important component of these models is to provide clinicians with the flexibility to customize (e.g., the prediction range) and use the risk prediction model that they deemed most beneficial for their patients. Therefore, in this paper, we develop MI prediction models and investigate the effect of sample age and prediction resolution on the performance of MI risk prediction models. The cardiovascular health study dataset was used in this study. Results indicate that the prediction model developed using SVM algorithm is capable of achieving high sensitivity, specificity, and balanced accuracy of 95.3%, 84.8%, and 90.1%, respectively, over a time span of 6 years. Both sample age and prediction resolution were found not to have a significant impact on the performance of MI risk prediction models developed using subjects aged 65 and above. This implies that risk prediction models developed using different sample age and prediction resolution is a feasible approach. These models can be integrated into a computer aided screening tool which clinicians can use to interpret and predict the MI risk status of the individual patients after performing the necessary clinical assessments (e.g., cognitive function, physical function, electrocardiography, general changes to health/lifestyle, and medications) required by the models. This could offer a means for clinicians to screen the patients at risk of having MI in the near future and prescribe early medical intervention to reduce the risk. PMID:24951711

  6. Low adiponectin levels and increased risk of type 2 diabetes in patients with myocardial infarction

    DEFF Research Database (Denmark)

    Lindberg, SØren; Jensen, Jan S

    2014-01-01

    OBJECTIVE: Patients with acute myocardial infarction (MI) have increased risk of developing type 2 diabetes mellitus (T2DM). Adiponectin is an insulin-sensitizing hormone produced in adipose tissue, directly suppressing hepatic gluconeogenesis, stimulating fatty acid oxidation and glucose uptake in skeletal muscle and insulin secretion. In healthy humans, low plasma adiponectin levels associate with increased risk of T2DM; however, the relationship between adiponectin and T2DM in patients with MI has never been investigated. RESEARCH DESIGN AND METHODS: We prospectively included 666 patients with ST-segment elevation MI, without diabetes, treated with percutaneous coronary intervention, from September 2006 to December 2008 at a tertiary cardiac center. Blood samples were drawn before intervention, and total plasma adiponectin was measured in all samples. During follow-up (median 5.7 years [interquartile range 5.3-6.1]) 6% (n = 38) developed T2DM. Risk of T2DM was analyzed using a competing risk analysis. RESULTS: Low adiponectin levels were associated with increased risk of T2DM (P < 0.001). Even after adjustment for confounding risk factors (age, sex, hypertension, hypercholesterolemia, current smoking, previous MI, BMI, blood glucose, total cholesterol, HDL, LDL, triglyceride, estimated glomerular filtration rate, C-reactive protein, peak troponin I, and proatrial natriuretic peptide), low adiponectin levels remained an independent predictor of T2DM (hazard ratio [HR] 5.8 [2.3-15.0]; P < 0.001). Importantly, plasma adiponectin added to the predictive value of blood glucose, with the combination of high blood glucose and low plasma adiponectin, vastly increasing the risk of developing T2DM (HR 9.6 [3.7-25.3]; P < 0.001). CONCLUSIONS: Low plasma adiponectin levels are independently associated with increased risk of T2DM in patients with MI and added significantly to the predictive value of blood glucose.

  7. Low Adiponectin Levels and Increased Risk of Type 2 Diabetes in Patients With Myocardial Infarction

    DEFF Research Database (Denmark)

    Lindberg, SØren; Jensen, Jan S

    2014-01-01

    OBJECTIVE: Patients with acute myocardial infarction (MI) have increased risk of developing type 2 diabetes mellitus (T2DM). Adiponectin is an insulin-sensitizing hormone produced in adipose tissue, directly suppressing hepatic gluconeogenesis, stimulating fatty acid oxidation and glucose uptake in skeletal muscle and insulin secretion. In healthy humans, low plasma adiponectin levels associate with increased risk of T2DM; however, the relationship between adiponectin and T2DM in patients with MI has never been investigated. RESEARCH DESIGN AND METHODS: We prospectively included 666 patients with ST-segment elevation MI, without diabetes, treated with percutaneous coronary intervention, from September 2006 to December 2008 at a tertiary cardiac center. Blood samples were drawn before intervention, and total plasma adiponectin was measured in all samples. During follow-up (median 5.7 years [interquartile range 5.3-6.1]) 6% (n = 38) developed T2DM. Risk of T2DM was analyzed using a competing risk analysis. RESULTS: Low adiponectin levels were associated with increased risk of T2DM (P < 0.001). Even after adjustment for confounding risk factors (age, sex, hypertension, hypercholesterolemia, current smoking, previous MI, BMI, blood glucose, total cholesterol, HDL, LDL, triglyceride, estimated glomerular filtration rate, C-reactive protein, peak troponin I, and proatrial natriuretic peptide), low adiponectin levels remained an independent predictor of T2DM (hazard ratio [HR] 5.8 [2.3-15.0]; P < 0.001). Importantly, plasma adiponectin added to the predictive value of blood glucose, with the combination of high blood glucose and low plasma adiponectin, vastly increasing the risk of developing T2DM (HR 9.6 [3.7-25.3]; P < 0.001). CONCLUSIONS: Low plasma adiponectin levels are independently associated with increased risk of T2DM in patients with MI and added significantly to the predictive value of blood glucose.

  8. Assessment of ICU readmission risk with the Stability and Workload Index for Transfer score*

    Science.gov (United States)

    Oakes, Daiane Ferreira; Borges, Ingrid Nemitz Krás; Forgiarini, Luiz Alberto; Rieder, Marcelo de Mello

    2014-01-01

    Patient discharge from the ICU is indicated on the basis of clinical evidence and the result of strategies aimed at improving health care. Nevertheless, some patients might be discharged too early. We attempted to identify risk factors for unplanned ICU readmission, using a score for risk assessment, designated the Stability and Workload Index for Transfer (SWIFT) score. We evaluated 100 patients discharged from an ICU and found that the SWIFT score can be used as a tool for improving the assessment of ICU patients and the appropriateness of ICU discharge, thus preventing readmission. PMID:24626273

  9. How much does HDL cholesterol add to risk estimation? A report from the SCORE Investigators.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2009-06-01

    Systematic COronary Risk Evaluation (SCORE), the risk estimation system recommended by the European guidelines on cardiovascular disease prevention, estimates 10-year risk of cardiovascular disease mortality based on age, sex, country of origin, systolic blood pressure, smoking status and either total cholesterol (TC) or TC\\/high-density lipoprotein cholesterol (HDL-C) ratio. As, counterintuitively, these two systems perform very similarly, we have investigated whether incorporating HDL-C and TC as separate variables improves risk estimation.

  10. Fatty Acid desaturase gene variants, cardiovascular risk factors, and myocardial infarction in the costa rica study.

    Science.gov (United States)

    Aslibekyan, S; Jensen, M K; Campos, H; Linkletter, C D; Loucks, E B; Ordovas, J M; Deka, R; Rimm, E B; Baylin, A

    2012-01-01

    Genetic variation in fatty acid desaturases (FADS) has previously been linked to long-chain polyunsaturated fatty acids (PUFAs) in adipose tissue and cardiovascular risk. The goal of our study was to test associations between six common FADS polymorphisms (rs174556, rs3834458, rs174570, rs2524299, rs174589, rs174627), intermediate cardiovascular risk factors, and non-fatal myocardial infarction (MI) in a matched population based case-control study of Costa Rican adults (n?=?1756). Generalized linear models and multiple conditional logistic regression models were used to assess the associations of interest. Analyses involving intermediate cardiovascular risk factors and MI were also conducted in two replication cohorts, The Nurses' Health Study (n?=?1200) and The Health Professionals Follow-Up Study (n?=?1295). In the Costa Rica Study, genetic variation in the FADS cluster was associated with a robust linear decrease in adipose gamma-linolenic, arachidonic, and eicosapentaenoic fatty acids, and significant or borderline significant increases in the eicosadienoic, eicosatrienoic, and dihomo-gamma-linolenic fatty acids. However, the associations with adipose tissue fatty acids did not translate into changes in inflammatory biomarkers, blood lipids, or the risk of MI in the discovery or the replication cohorts. In conclusion, fatty acid desaturase polymorphisms impact long-chain PUFA biosynthesis, but their overall effect on cardiovascular health likely involves multiple pathways and merits further investigation. PMID:22563332

  11. Dutch women with a low birth weight have an increased risk of myocardial infarction later in life: a case control study

    OpenAIRE

    Rosendaal Frits R; Hage Ronella M; Kapiteijn Kitty; Tanis Bea C; Helmerhorst Frans M

    2005-01-01

    Abstract Background To investigate whether low birth weight increases the risk of myocardial infarction later in life in women. Methods Nationwide population-based case-control study. Patients and controls: 152 patients with a first myocardial infarction before the age of 50 years in the Netherlands. 568 control women who had not had a myocardial infarction stratified for age, calendar year of the index event, and area of residence. Results Birth weight in the patient group was significantly ...

  12. Patients with Knee Osteoarthritis Undergoing Total Knee Arthroplasty Have a Lower Risk of Subsequent Severe Cardiovascular Events: Propensity Score and Instrumental Variable Analysis

    Science.gov (United States)

    Hsu, Chia-Wen; Huang, Kuang-Yung; Lyu, Shaw-Ruey

    2015-01-01

    Objective This population-based study investigated the subsequent cardiovascular risk of patients with knee osteoarthritis underwent total knee arthroplasty in Taiwan. Materials and methods This was a population-based follow-up study of 22931 patients diagnosed with knee osteoarthritis between 2008 and 2011. Each patient was followed for 3 years or until death. Treatment was dichotomized into conservative treatment and TKA. The association between TKA and cardiovascular disease (CVD) events was analyzed using propensity score analysis and instrumental variable analysis and two-stage least-squares regression model. Results Patients with knee osteoarthritis who underwent TKA had a lower 3-year cumulative risk of stroke and acute myocardial infarction (AMI). After adjusting for measured risk and confounding factors, propensity score showed a 0.56 fold (adjusted OR = 0.56; 95% CI, 0.51–0.61; p<0.001) risk for CVD in those with TKA. Use of instrumental variable analysis for adjusting measured and unmeasured factors and two-stage least squares regression model revealed that the average treatment effect of TKA was statistically associated with a decreased 7% risk of CVD events (95% CI, 0.2%–13.6%). Conclusion Our study revealed that patients with knee osteoarthritis who underwent TKA had a lower risk of suffering from a future severe cardiovascular event. This benefit may be attributed to an improvement in physical activity, reduction of psychosocial stress, and/or a decreased use of NSAIDs as a result of having undergone TKA. PMID:26010912

  13. Valproate attenuates the risk of myocardial infarction in patients with epilepsy: a nationwide cohort study

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Hansen, Peter Riis

    2011-01-01

    PURPOSE: Patients with epilepsy have increased risk of myocardial infarction (MI). Valproate can exert anti-atherosclerotic effects. We therefore examined the risk of MI in patients with epilepsy receiving valproate. METHODS: Two cohorts of patients with valproate-treated epilepsy and sex- and age-matched individuals (controls) from the general Danish population were identified by individual-level-linkage of nationwide registries and followed for 10 years. The two cohorts comprised patients treated with valproate at baseline and valproate-naïve patients initiating treatment in the study period, respectively. The hazard ratios (HR) of MI and all-cause death were estimated by two different Cox proportional-hazard models; valproate treatment was analysed as a baseline categorical covariate in the first cohort and as a time-dependent exposure covariate in the second cohort. RESULTS: The two cohorts comprised 53¿086 and 102¿003 individuals, respectively. In the first cohort, the risk of MI was decreased (HR 0.75, 95% confidence interval 0.59-0.97) while the risk of all-cause death was increased (HR 2.11, 95% confidence interval 1.95-2.28), compared to the controls. In the second cohort, the risk of MI was decreased (HR 0.62, 95% confidence interval 0.53-0.73) while the risk of all-cause death was similar to the controls (HR 1.02, 95% confidence interval 0.97-1.07). CONCLUSIONS: In this nationwide pharmacoepidemiological study, we found a consistent association between valproate treatment and a reduced risk of MI in patients with epilepsy. Copyright © 2010 John Wiley & Sons, Ltd.

  14. HIV infection does not contribute to increased cardiovascular risk as assessed by Framingham risk score

    Directory of Open Access Journals (Sweden)

    I Ramsay

    2012-11-01

    Full Text Available HIV-1-infected patients are thought to be at higher risk of cardiovascular events. Measures of arterial stiffness are independently associated with cardiovascular risk [1]. The aim of our study was to determine if higher Framingham risk is associated with higher carotid femoral pulse wave velocity (cfPWV in HIV-infected volunteers (HIV cohort and to establish whether there is a difference in cfPWV between the HIV cohort and age- and gender-matched controls. We recruited 47 males (HIV cohort on antiretroviral treatment, from a UK HIV clinic between October 2010 and March 2012 (31 low Framingham risk <10% and 16 high risk >20%. This group was matched with 46 healthy subjects from a contemporaneous study performed by our group. The inclusion criteria were: age 35–75 years with Framingham risk >20% or <10%, on antiretroviral treatment with undetectable viral load, no previous coronary heart disease, stroke or insulin therapy. Subjects underwent cfPWV measurement using Complior® (Artech, France. Student's t-test was used to evaluate differences between high- and low-risk groups and also between cases and controls. The mean age of the HIV cohort was 49.43±9.35 years (mean±SD and in the control group 52.20±8.80 years (p=0.15. Mean duration of HIV infection was 13.83±7.25 years, mean CD4 count was 728.81±312.62×106/L and all viral loads were undetectable. In the HIV cohort, cfPWV was 8.39±1.09 m/s in the low-risk group and 10.43±2.93 m/s in the high-risk group (p=0.02. Multivariate analysis with cfPWV as dependent variable, and age, systolic blood pressure, cholesterol, smoking history, duration of HIV infection and antiretroviral therapy, zenith viral loads and nadir CD4 counts as independent variables was performed in the high- and low-risk groups. This showed age alone to be a significant predictive factor (p=0.002. With Framingham risk as dependent variable and using the above factors as independent variables, no HIV-related factors were significant predictors. The overall mean cfPWV for the HIV cohort (n=47 was 9.09±2.13 m/s compared to 11.95±2.37 m/s in the control group (n=46(p<0.01. HIV infection does not contribute to increased cardiovascular risk as assessed by Framingham risk score or carotid-femoral pulse wave velocity. This may be due to good control of traditional cardiovascular risk factors and a healthy lifestyle in this cohort.

  15. Declining Relative Risk for Myocardial Infarction Among HIV-Positive Compared With HIV-Negative Individuals With Access to Care.

    Science.gov (United States)

    Klein, Daniel B; Leyden, Wendy A; Xu, Lanfang; Chao, Chun R; Horberg, Michael A; Towner, William J; Hurley, Leo B; Marcus, Julia L; Quesenberry, Charles P; Silverberg, Michael J

    2015-04-15

    Concerns remain for an increased myocardial infarction (MI) risk among individuals infected with human immunodeficiency virus (HIV). We conducted a cohort study evaluating MI risk from 1996 to 2011 by HIV status. The adjusted MI rate ratio for HIV status declined over time, reaching 1.0 (95% confidence interval, .7-1.4) in 2010-2011, the most recent study period. PMID:25595743

  16. Cardiovascular disease risk score prediction models for women and its applicability to Asians

    Directory of Open Access Journals (Sweden)

    Goh LGH

    2014-03-01

    Full Text Available Louise GH Goh,1 Satvinder S Dhaliwal,1 Timothy A Welborn,2 Peter L Thompson,2–4 Bruce R Maycock,1 Deborah A Kerr,1 Andy H Lee,1 Dean Bertolatti,1 Karin M Clark,1 Rakhshanda Naheed,1 Ranil Coorey,1 Phillip R Della5 1School of Public Health, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia; 2Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia; 3School of Population Health, University of Western Australia, Perth, WA, Australia; 4Harry Perkins Institute for Medical Research, Perth, WA, Australia; 5School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia Purpose: Although elevated cardiovascular disease (CVD risk factors are associated with a higher risk of developing heart conditions across all ethnic groups, variations exist between groups in the distribution and association of risk factors, and also risk levels. This study assessed the 10-year predicted risk in a multiethnic cohort of women and compared the differences in risk between Asian and Caucasian women. Methods: Information on demographics, medical conditions and treatment, smoking behavior, dietary behavior, and exercise patterns were collected. Physical measurements were also taken. The 10-year risk was calculated using the Framingham model, SCORE (Systematic COronary Risk Evaluation risk chart for low risk and high risk regions, the general CVD, and simplified general CVD risk score models in 4,354 females aged 20–69 years with no heart disease, diabetes, or stroke at baseline from the third Australian Risk Factor Prevalence Study. Country of birth was used as a surrogate for ethnicity. Nonparametric statistics were used to compare risk levels between ethnic groups. Results: Asian women generally had lower risk of CVD when compared to Caucasian women. The 10-year predicted risk was, however, similar between Asian and Australian women, for some models. These findings were consistent with Australian CVD prevalence. Conclusion: In summary, ethnicity needs to be incorporated into CVD risk assessment. Australian standards used to quantify risk and treat women could be applied to Asians in the interim. The SCORE risk chart for low-risk regions and Framingham risk score model for incidence are recommended. The inclusion of other relevant risk variables such as obesity, poor diet/nutrition, and low levels of physical activity may improve risk estimation. Keywords: cardiovascular disease prevention, risk assessment, epidemiology, Asia, female

  17. Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI : a correlation with histopathology

    DEFF Research Database (Denmark)

    Boesen, Lars; Chabanova, Elizaveta

    2015-01-01

    OBJECTIVES: To evaluate the diagnostic performance of preoperative multiparametric MRI with extracapsular extension (ECE) risk-scoring in the assessment of prostate cancer tumour stage (T-stage) and prediction of ECE at final pathology. MATERIALS AND METHODS: Eighty-seven patients with clinically localised prostate cancer scheduled for radical prostatectomy were prospectively enrolled. Multiparametric MRI was performed prior to prostatectomy, and evaluated according to the ESUR MR prostate guidelines by two different readers. An MRI clinical T-stage (cTMRI), an ECE risk score, and suspicion of ECE based on tumour characteristics and personal opinion were assigned. Histopathological prostatectomy results were standard reference. RESULTS: Histopathology and cTMRI showed a spearman rho correlation of 0.658 (p?risk-scoring showed an AUC of 0.65-0.86 on ROC-curve for both readers, with sensitivity and specificity of 81 % and 78 % at best cutoff level (reader A), respectively. When tumour characteristics were influenced by personal opinion, the sensitivity and specificity for prediction of ECE changed to 61 %-74 % and 77 %-88 % for the readers, respectively. CONCLUSIONS: Multiparametric MRI with ECE risk-scoring is an accurate diagnostic technique in determining prostate cancer clinical tumour stage and ECE at final pathology. KEY POINTS: • Multiparametric MRI is an accurate diagnostic technique for preoperative prostate cancer staging • ECE risk scoring predicts extracapsular tumour extension at final pathology • ECE risk scoring shows an AUC of 0.86 on the ROC-curve • ECE risk scoring shows a moderate inter-reader agreement (K?=?0.45) • Multiparametric MRI provides essential knowledge for optimal clinical management.

  18. High-risk myocardial infarction patients appear to derive more mortality benefit from short door-to-balloon time than low-risk patients

    OpenAIRE

    Kong, Poi Keong; Connolly, Derek; Varma, Chetan; Lip, Gregory; Millane, Teri; Davis, Russell; Ahmad, Rajai

    2009-01-01

    Abstract Objectives: To evaluate reduction of door-to-balloon (DTB) time and its impact on in-hospital mortality of high-risk infarct patients in a collaboration of district general hospitals (DGH) with a physician-to-patient model. Methods: Primary percutaneous coronary interventions (PPCI) with short DTB time offer mortality benefit for STEMI but literatures are conflicting on this benefit for high-risk versus low-risk patients. In a unique model at Sandwell and West Bi...

  19. Using decision trees to manage hospital readmission risk for acute myocardial infarction, heart failure, and pneumonia.

    Science.gov (United States)

    Hilbert, John P; Zasadil, Scott; Keyser, Donna J; Peele, Pamela B

    2014-12-01

    To improve healthcare quality and reduce costs, the Affordable Care Act places hospitals at financial risk for excessive readmissions associated with acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN). Although predictive analytics is increasingly looked to as a means for measuring, comparing, and managing this risk, many modeling tools require data inputs that are not readily available and/or additional resources to yield actionable information. This article demonstrates how hospitals and clinicians can use their own structured discharge data to create decision trees that produce highly transparent, clinically relevant decision rules for better managing readmission risk associated with AMI, HF, and PN. For illustrative purposes, basic decision trees are trained and tested using publically available data from the California State Inpatient Databases and an open-source statistical package. As expected, these simple models perform less well than other more sophisticated tools, with areas under the receiver operating characteristic (ROC) curve (or AUC) of 0.612, 0.583, and 0.650, respectively, but achieve a lift of at least 1.5 or greater for higher-risk patients with any of the three conditions. More importantly, they are shown to offer substantial advantages in terms of transparency and interpretability, comprehensiveness, and adaptability. By enabling hospitals and clinicians to identify important factors associated with readmissions, target subgroups of patients at both high and low risk, and design and implement interventions that are appropriate to the risk levels observed, decision trees serve as an ideal application for addressing the challenge of reducing hospital readmissions. PMID:25160603

  20. Early Risk stratification for Arrhythmic death in Patients with ST-Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Sadr-Ameli

    2007-01-01

    Full Text Available Background: Sudden cardiac death is a leading cause of death in patients with ST-elevation myocardial infarction (MI. According to high cost of modern therapeutic modalities it is of paramount importance to define protocols for risk stratification of post-MI patients before considering expensive devices such as implantable cardioverter-defibrillator.Methods: One hundred and thirty seven patients with acute ST-elevation MI were selected and underwent echocardiographic study, holter monitoring and signal-averaged electrocardiography (SAECG. Then, the patients were followed for 12 ±3 months.Results: During follow-up, 13 deaths (9.5% occurred; nine cases happened as sudden cardiac death (6.6%. The effect of ejection fraction (EF less than 40% on occurrence of arrhythmic events was significant (P<0.001. Sensitivity and positive predictive value of EF<40% was 100% and 76.95% respectively. Although with lesser sensitivity and predictive power than EF<40%, abnormal heart rate variability (HRV and SAECG had also significant effects on occurrence of sudden death (P=0.02 and P=0.003 respectively. Nonsustained ventricular tachycardia was not significantly related to risk of sudden death in this study (P=0.20.Conclusions: This study indicated that EF less than 40% is the most powerful predictor of sudden cardiac death in post MI patients. Abnormal HRV and SAECG are also important predictors and can be added to EF for better risk stratification.

  1. Correlation Between Umbilical Cord pH and Apgar Score in High-Risk Pregnancy

    Directory of Open Access Journals (Sweden)

    Mahmood Hajiahmadi

    2010-12-01

    Full Text Available Objective:The Apgar score as a proven useful tool for rapid assessment of the neonate is often poorly correlated with other indicators of intrapartum neonatal well-being. This study was carried out to determine the correlation between umbilical cord pH and Apgar score in high-risk pregnancies. Methods:This is a prospective cross-sectional, analytic study performed on 96 mother-fetal pairs during 2004-2005 at Shahid Yahyanejad hospital, which is affiliated to Babol University of Medical Sciences. Apgar score at 1 and 5 minutes after birth was taken and an umbilical cord blood gas analysis was done immediately after birth in both groups. Mothers came with a labor pain and were divided into high-risk and low risk if they have had any perinatal risk factors. Other data like gestational age, birth weight, need for resuscitation and admission to the newborn ward or NICU was gathered by a questionnaire for comparison between the two groups. P-value less than 0.05 was considered being significant. Findings:The gestational age and birth weight were the same in high-risk and low risk mothers. Mean umbilical artery blood pH in high-risk mothers was significantly lower than in low risk mothers (P=0.004. Mean Apgar scores at 1 and 5 minutes were significantly lower in high-risk mothers than in low risk mothers (P<0.05. According to the Kendal correlation coefficient there was no significant correlation between Apgar score at 1 and 5 minutes and umbilical cord pH in low risk group (r=0.212, P=0.1. But in high-risk group there was significant correlation between Apgar score at 1st and 5th minute and the umbilical cord pH (r=0.01, P=0.036 and r=0.176, P=0.146, respectively. Conclusion:Combination of Apgar score and umbilical cord pH measurement in high-risk pregnant mother could better detect jeopardized baby.

  2. A scoring system to predict superinfections in high-risk febrile neutropenic children with cancer

    Scientific Electronic Library Online (English)

    Hugo, Paganini; Juliana, Caccavo; Clarisa, Aguirre; Sandra, Gómez; Pedro, Zubizarreta.

    2011-02-01

    Full Text Available Background. No scoring system has been published to date to assess the risk of superinfections (SI) for high-risk children with febrile neutropenia (HRFN). Methods. SI diagnoses during or 1 week after initiating antibiotic therapy in HRFN children were evaluated. Eight hundred and forty-nine episode [...] s of febrile neutropenia (FN) were included in a prospective study to evaluate a scoring system designed to identify SI. Results. In the derivation set (566 episodes), 17% had SI. A multivariate analysis identified the following significant SI-related risk factors: acute lymphoblastic leukemia-acute myeloid leukemia (ALL-AML, OR, 1.87; 95% CI, 1.13-3.10), central venous catheter (OR, 2.11; 95% CI, 1.23-3.62), and febrile episode occurring within 10 days after chemotherapy (OR, 1.86; 95% CI, 1.09-3.15). A SI scoring system could be built: 1 point for ALL-AML, 1 point for the presence of a central venous catheter, and 1 point for the febrile episode occurring within 10 days after chemotherapy. If patients collected 3 points, then their risk of SI was 25.8%. With 2 points the risk was 16.7%, and with one minimum score of 1 point, their risk was 10.9%. The sensitivity to predict SS was 100% and its negative predictive value (NPV) was 100%. In the validation set (283 episodes), 49 (17%) children had SI. For children with scores > 0, the scoring system yielded a sensitivity of 100%, and a NPV of 100% for predicting SI. Conclusions. The use of a SI score for HRFN patients was statistically validated by these results. A better initial predictive approach may allow improved therapeutic decisions for these children.

  3. Polygenic Risk Score Improves Prostate Cancer Risk Prediction: Results from the Stockholm-1 Cohort Study

    Science.gov (United States)

    Aly, Markus; Wiklund, Fredrik; Xu, Jianfeng; Isaacs, William B.; Eklund, Martin; D’Amato, Mauro; Adolfsson, Jan; Grönberg, Henrik

    2015-01-01

    Background More than 1 million prostate biopsies are conducted yearly in the United States. The low specificity of prostate-specific antigen (PSA) results in diagnostic biopsies in men without prostate cancer (PCa). Additional information, such as genetic markers, could be used to avoid unnecessary biopsies. Objective To determine whether single nucleotide polymorphisms (SNPs) associated with PCa can be used to determine whether biopsy of the prostate is necessary. Design, settings, and participants The Stockholm-1 cohort (n = 5241) consisted of men who underwent a prostate biopsy during 2005 to 2007. PSA levels were retrieved from databases and family histories were obtained using a questionnaire. Thirty-five validated SNPs were analysed and converted into a genetic risk score that was implemented in a risk-prediction model. Results and limitations When comparing the nongenetic model (based on age, PSA, free-to-total PSA, and family history) with the genetic model and using a fixed number of detected PCa cases, it was found that the genetic model required significantly fewer biopsies than the nongenetic model, with 480 biopsies (22.7%) avoided, at a cost of missing a PCa diagnosis in 3% of patients characterised as having an aggressive disease. However, the overall genetic model does not discriminate between aggressive and nonaggressive cases. Conclusion Although the genetic model reduced the number of biopsies more than the nongenetic model, the clinical significance of this finding requires further evaluation. PMID:21295399

  4. Active and passive smoking and the risk of myocardial infarction in 24,968 men and women during 11 year of follow-up: the Tromsø Study

    OpenAIRE

    Iversen, Birgitte; Jacobsen, Bjarne K.; Løchen, Maja-Lisa

    2013-01-01

    Active smoking is a well-established risk factor for myocardial infarction, but less is known about the impact of passive smoking, and possible sex differences in risk related to passive smoking. We investigated active and passive smoking as risk factors for myocardial infarction in an 11-year follow-up of 11,762 men and 13,206 women included in the Tromsø Study. There were a total of 769 and 453 incident cases of myocardial infarction in men and women, respectively. We found linear age-adju...

  5. Early risk predictors of sudden cardiac death after myocardial infarction: Results of follow up of 881 patients

    Directory of Open Access Journals (Sweden)

    Milovanovi? Branislav

    2006-01-01

    Full Text Available Introduction: It has been shown that depolarization disorders, autonomic dysfunction, and systolic dysfunction of the left ventricle are associated with sudden cardiac death after myocardial infarction. Objective: The Objective of study was to examine the prognostic value of the most important predictors in the first week after myocardial infarction. Method: Study included 881 patients who were followed up from 1 to 60 months. During the first week after myocardial infarction, following examination were performed: ECG with standard leads and X, Y, Z orthogonal leads, vectorcardiogram, QT interval, late potentials, short-time spectral analysis of RR variability, nonlinear (Poincare plot analysis and echocardiogram. Results: In univariate analysis, the following parameters measured on the first day were important predictors of sudden cardiac death: lower LF/HF ratio(<1.5 (p=0.000, T wave inversion in X lead (p=0.000, high P wave in D2 lead (p=0.030, and diminished systolic function (p=0.000. In multivariate analysis, the following parameters were significant risk predictors: T wave inversion in X lead, lower LF/HF ratio, positive late potentials and the left ventricle systolic dysfunction. Conclusion: The parameters of the left ventricle systolic dysfunction with sympathicovagal imbalance and electric instability are the key risk predictors in the first few days after myocardial infarction.

  6. A Novel Fatty Acid Profile Index—the Lipophilic Index—and Risk of Myocardial Infarction

    Science.gov (United States)

    Toledo, Estefania; Campos, Hannia; Ding, Eric L.; Wu, Hongyu; Hu, Frank B.; Sun, Qi; Baylin, Ana

    2013-01-01

    The lipophilic index (LI), a mean measure of fatty acid melting points, has been proposed to capture overall fatty acid profile and may play an important role in the etiology of coronary heart disease. We aimed to determine the association between LI in diet and in adipose tissue and metabolic risk factors for myocardial infarction (MI) and risk of MI. We used a population-based, matched case-control study of nonfatal first acute MI conducted in Costa Rica between 1994 and 2004, with 1,627 case-control pairs. The LI is defined as the mean of the melting points of specific fatty acids in diet or adipose tissue. LIs in diet and adipose tissue were significantly associated with higher plasma triglyceride concentrations, low-density lipoprotein cholesterol concentrations, and low-density:high-density lipoprotein cholesterol ratio. Comparing extreme quintiles for the LI in diet or adipose tissue, the odds ratios for MI were 1.57 (95% confidence interval: 1.22, 2.02; P for trend < 0.001) for dietary LI and 1.30 (95% confidence interval: 1.00, 1.69; P for trend = 0.02) for adipose tissue LI in the multivariable models. We hypothesize that a higher LI in diet and in adipose tissue represents decreased fatty acid fluidity and could play an important role in the etiology of coronary heart disease. PMID:23785111

  7. Impact of acute hyperglycemia on myocardial infarct size, area at risk and salvage in patients with ST elevation myocardial infarction and the association with exenatide treatment - results from a randomized study

    DEFF Research Database (Denmark)

    LØnborg, Jacob Thomsen; Vejlstrup, Niels Grove

    2014-01-01

    Hyperglycemia upon admission in ST-segment elevation myocardial infarction (STEMI) patients occurs frequently and is associated with adverse outcome. It is however unsettled whether elevated blood glucose is the cause or consequence of increased myocardial damage. In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this sub-study were to evaluate the association between hyperglycemia and infarct size, myocardial salvage and area-at-risk, and to assess the interaction between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area-at-risk and infarct size compared to patients with normoglycemia, but the salvage index and infarct size adjusting for area-at-risk did not differ between the groups. Treatment with exenatide resulted in increased salvage index both among patients with normoglycemia and hyperglycemia. Thus, we conclude that the association between hyperglycemia upon admission and infarct size in STEMI patients is a consequence of a larger myocardial area-at-risk but not on a reduction in myocardial salvage. Also, cardioprotection by exenatide treatment is independent of admission glucose levels. Thus, hyperglycemia does not influence the effect of the reperfusion treatment but rather represents a surrogate marker for the severity of myocardium at risk and injury.

  8. Risk Score Model for Predicting Sonographic Non-Alcoholic Fatty Liver Disease in Children and Adolescents

    Directory of Open Access Journals (Sweden)

    Parinaz Poursafa

    2011-06-01

    Full Text Available Objective: This study aimed to develop and test the validity of a risk score to be used as a simple tool to identify those children at high risk of sonographic non-alcoholic fatty liver disease (NAFLD. Methods:This cross-sectional study was conducted among 962 participants aged 6-18 years in Isfahan, Iran. They consisted of three groups of nearly equal number of normal-weight, overweight and obese individuals. Coefficients of the logistic regression models were used to assign a score value for each variable and the composite sonographic NAFLD risk score was calculated as the sum of those scores. Performance of model was assessed by receiver operating characteristic (ROC curve procedure. Findings:Data of 931 participants was included in the analysis. The sonographic findings of 16.8% of participants were compatible with NAFLD. Age, sex, body mass index, waist circumference and serum triglycerides level were diagnosed as factors associated with NAFLD. The risk score was calculated as 50 for sonographic NAFLD. Conclusion:This study, to the best of our knowledge is the first of its kind in the pediatric age group, focuses on predicting sonographic NAFLD from easily-measured factors. It may suggest an association of hypertriglyceridemic-waist phenotype with NAFLD in the pediatric age group.

  9. PROSPECTS FOR THE USE OF GENOTYPING FOR CHROMOSOME 9p21.3 POLYMORPHISMS FOR MYOCARDIAL INFARCTION RISK STRATIFICATION IN YOUNG PEOPLE

    Directory of Open Access Journals (Sweden)

    P. A. Shesternya

    2014-07-01

    Full Text Available Objective: to study whether genotyping for single nucleotide polymorphisms (SNPs rs10757278 and rs1333049 on the 9p21.3 locus may be applied to myocardial infarction (MI risk stratification using the SCORE scale in young people (less than 45 years.Subjects and methods. A group of patients with MI (n = 103 and a control group (n = 111 showed no statistically significant differences ingender, age, hypertension, diabetes mellitus, hypercholesterolemia, overweight and obesity, abdominal obesity, and smoking history. The phenolchloroform method was employed to extract genomic DNA from venous blood. Genetic tests were carried out using real-time polymerasechain reaction systems (TagMan and AB 7900HT.Results. There was a statistically significant association of rs1333049 and rs 10757278 with the development of MI. The odds ratio for the latter was 2.53 (95 % confidence interval (CI 1.31-4.89 in carriers of the risk allele C of rs1333049 and 2.11 (95 % CI 1.11–4.01 in those with the risk allele G of rs10757278. The statistical significance also remained with consideration for the family history of MI. Multiple logistic regression analysis established that the presence of the C allele of rs1333049 in the genotype was of great predictive value as compared with the high/very high risk of fatal and nonfatal events according to the SCORE scale.Conclusion. SNPs 1333049 and rs10757278 on the 9p21.3 locus are the predictors of MI in young people, which are independent of both traditional risk factors and family history. Having regard to the pattern of an association, it will suffice to genotype one of them, namely rs 1333049, in our population

  10. Post-operative acute kidney injury and five-year risk of death, myocardial infarction, and stroke among elective cardiac surgical patients : a cohort study

    DEFF Research Database (Denmark)

    Hansen, Malene Kærslund; Gammelager, Henrik

    2013-01-01

    The prognostic impact of acute kidney injury (AKI) on long-term clinical outcomes remains controversial. We examined the five-year risk of death, myocardial infarction, and stroke after elective cardiac surgery complicated by AKI.

  11. SNPs in microRNA binding sites in 3'-UTRs of RAAS genes influence arterial blood pressure and risk of myocardial infarction

    DEFF Research Database (Denmark)

    Nossent, Anne Yaël; Hansen, Jakob Liebe

    2011-01-01

    We hypothesized that single nucleotide polymorphisms (SNPs) located in microRNA (miR) binding sites in genes of the renin angiotensin aldosterone system (RAAS) can influence blood pressure and risk of myocardial infarction.

  12. The cerebrospinal fluid HIV risk score for assessing central nervous system activity in persons with HIV.

    Science.gov (United States)

    Hammond, Edward R; Crum, Rosa M; Treisman, Glenn J; Mehta, Shruti H; Marra, Christina M; Clifford, David B; Morgello, Susan; Simpson, David M; Gelman, Benjamin B; Ellis, Ronald J; Grant, Igor; Letendre, Scott L; McArthur, Justin C

    2014-08-01

    Detectable human immunodeficiency virus (HIV) RNA in the cerebrospinal fluid (CSF) is associated with central nervous system (CNS) complications. We developed the CSF HIV risk score through prediction modeling to estimate the risk of detectable CSF HIV RNA (threshold >50 copies/mL) to help identify persons who might benefit most from CSF monitoring. We used baseline data from 1,053 participants receiving combination antiretroviral therapy who were enrolled in the 6-center, US-based CNS HIV Antiretroviral Therapy Effects Research (CHARTER) prospective cohort in 2004-2007. Plasma HIV RNA, CNS penetration effectiveness, duration of combination antiretroviral therapy, medication adherence, race, and depression status were retained correlates of CSF HIV RNA, displaying good discrimination (C statistic = 0.90, 95% confidence interval (CI): 0.87, 0.93) and calibration (Hosmer-Lemeshow P = 0.85). The CSF HIV risk score ranges from 0 to 42 points, with a mean of 15.4 (standard deviation, 7.3) points. At risk scores greater than 25, the probability of detecting CSF HIV RNA was at least 42.9% (95% CI: 36.6, 49.6). For each 1-point increase, the odds of detecting CSF HIV RNA increased by 26% (odds ratio = 1.26, 95% CI: 1.21, 1.31; P < 0.01). The risk score correlates with detection of CSF HIV RNA. It represents an advance in HIV management and monitoring of CNS effects, providing a potentially useful tool for clinicians. PMID:24966216

  13. Risk prediction is improved by adding markers of subclinical organ damage to SCORE

    DEFF Research Database (Denmark)

    Sehestedt, Thomas; Jeppesen, JØrgen

    2009-01-01

    Aims It is unclear whether subclinical vascular damage adds significantly to Systemic Coronary Risk Evaluation (SCORE) risk stratification in healthy subjects. Methods and results In a population-based sample of 1968 subjects without cardiovascular disease or diabetes not receiving any cardiovascular, anti-diabetic, or lipid-lowering treatment, aged 41, 51, 61, or 71 years, we measured traditional cardiovascular risk factors, left ventricular (LV) mass index, atherosclerotic plaques in the carotid arteries, carotid/femoral pulse wave velocity (PWV), and urine albumin/creatinine ratio (UACR) and followed them for a median of 12.8 years. Eighty-one subjects died because of cardiovascular causes. Risk of cardiovascular death was independently of SCORE associated with LV hypertrophy [hazard ratio (HR) 2.2 (95% CI 1.2-4.0)], plaques [HR 2.5 (1.6-4.0)], UACR >/= 90th percentile [HR 3.3 (1.8-5.9)], PWV > 12 m/s [HR 1.9 (1.1-3.3) for SCORE >/= 5% and 7.3 (3.2-16.1) for SCORE /= 5% as well as subclinical organ damage, increased specificity of risk prediction from 75 to 81% (P /= 5% to include subjects with 1%

  14. Apixaban and risk of myocardial infarction: meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Tornyos, Adrienn; Vorobcsuk, András; Kupó, Péter; Aradi, Dániel; Kehl, Dániel; Komócsi, András

    2015-07-01

    The coagulation system contributes greatly to the evolution of myocardial infarction (MI). Anticoagulation may reduce the occurrence of MI as monotherapy or with concomitant use of aspirin. Activated factor X antagonists (anti-Xa) and direct thrombin inhibitors have promising results in various indications in non-inferiority trials. However, results regarding their cardiovascular safety are heterogeneous. We systematically evaluated the risk of MI and mortality in patients receiving the new-generation oral anti-Xa agent apixaban. Electronic databases were searched to find prospective, randomized, controlled clinical trials (RCT) that evaluated the clinical impact of apixaban. Efficacy measures included frequency of MI, cardiovascular and overall mortality. Outcome parameters of RCTs were pooled with a random-effects model. Between January 2000 and December 2013, 12 RCTs comprising 54,054 patients were identified. Based on the pooled results, there was no increase in the risk of MI in patients treated with apixaban [odds ratio (OR) 0.90; 95 % confidence interval (CI) 0.77-1.05; p = 0.17] compared to different controls. Cardiovascular and overall mortality with apixaban was comparable to the control groups (OR 0.88; 95 % CI 0.72-1.06; p = 0.18, OR 0.89; 95 % CI 0.77-1.03; p = 0.11, respectively). The pooled risk of major bleeding was lower in the apixaban treated groups (OR 0.84; 95 % CI 0.62-1.12; p = 0.23) however this reached significant level only in subgroup analysis of trials with anticoagulant regimes in the control (OR 0.66; 95 % CI 0.51-0.87; p = 0.003). In a broad spectrum of patients and compared to different controls apixaban treatment was not associated with an increase in MI or mortality. PMID:25059624

  15. Diabetes Risk Factors, Diabetes Risk Algorithms, and the Prediction of Future Frailty: The Whitehall II Prospective Cohort Study. : Diabetes risk scores and frailty

    OpenAIRE

    Bouillon, Kim; Kivima?ki, Mika; Hamer, Mark; Shipley, Martin; Akbaraly, Tasnime; Tabak, Adam; Singh-manoux, Archana; Batty, David

    2013-01-01

    OBJECTIVE: To examine whether established diabetes risk factors and diabetes risk algorithms are associated with future frailty. DESIGN: Prospective cohort study. Risk algorithms at baseline (1997-1999) were the Framingham Offspring, Cambridge, and Finnish diabetes risk scores. SETTING: Civil service departments in London, United Kingdom. PARTICIPANTS: There were 2707 participants (72% men) aged 45 to 69 years at baseline assessment and free of diabetes. MEASUREMENTS: Risk factors (age, sex, ...

  16. Risk of venous thromboembolism and myocardial infarction associated with factor V Leiden and prothrombin mutations and blood type

    DEFF Research Database (Denmark)

    Sode, Birgitte Margareta; Allin, Kristine H

    2013-01-01

    ABO blood type locus has been reported to be an important genetic determinant of venous and arterial thrombosis in genome-wide association studies. We tested the hypothesis that ABO blood type alone and in combination with mutations in factor V Leiden R506Q and prothrombin G20210A is associated with the risk of venous thromboembolism and myocardial infarction in the general population.

  17. Escores de risco nas intervenções em valvopatia / Risk scores in valvular heart disease interventions

    Scientific Electronic Library Online (English)

    Ricardo, Casalino; Flávio, Tarassoutchi.

    2012-05-01

    Full Text Available Os escores de risco utilizados assistencialmente em clínica de valvopatia já apresentam validações em todo mundo, entretanto, os dados não são homogêneos. As características epidemiológicas de cada população requerem uma validação local dessas ferramentas de risco. A troca valvar percutânea, que já [...] é uma realidade em doença valvar (principalmente na estenose aórtica), está indicada em pacientes com risco cirúrgico elevado ou considerado proibitivo. Os estudos com essa nova estratégia de tratamento utilizam os escores de risco como um dos critérios de inclusão e são escassos trabalhos que utilizam tais ferramentas como preditoras de risco. Os escores de risco depois de validados em suas respectivas populações vieram para somar com a prática clínica (individualização da conduta) na definição da conduta em clínica de valvopatia. Abstract in english The risk scores used as assistance agents in valve diseases are validated worldwide; however, the data are not homogeneous. The epidemiological characteristics of each population require local validation of these risk tools. The percutaneous valve replacement, which is a reality in valvular diseases [...] (especially aortic stenosis), is indicated for patients with high or prohibitive surgical risk. Studies with this new treatment strategy use risk scores as criteria for inclusion and there are few studies that use such tools as predictors of risk. The risk scores, after due validation in their relevant populations, are combined with clinical practice (individualization of conduct) in the definition of the conduct to be adopted in the clinical practice of valvular heart disease.

  18. Escores de risco nas intervenções em valvopatia Risk scores in valvular heart disease interventions

    Directory of Open Access Journals (Sweden)

    Ricardo Casalino

    2012-05-01

    Full Text Available Os escores de risco utilizados assistencialmente em clínica de valvopatia já apresentam validações em todo mundo, entretanto, os dados não são homogêneos. As características epidemiológicas de cada população requerem uma validação local dessas ferramentas de risco. A troca valvar percutânea, que já é uma realidade em doença valvar (principalmente na estenose aórtica, está indicada em pacientes com risco cirúrgico elevado ou considerado proibitivo. Os estudos com essa nova estratégia de tratamento utilizam os escores de risco como um dos critérios de inclusão e são escassos trabalhos que utilizam tais ferramentas como preditoras de risco. Os escores de risco depois de validados em suas respectivas populações vieram para somar com a prática clínica (individualização da conduta na definição da conduta em clínica de valvopatia.The risk scores used as assistance agents in valve diseases are validated worldwide; however, the data are not homogeneous. The epidemiological characteristics of each population require local validation of these risk tools. The percutaneous valve replacement, which is a reality in valvular diseases (especially aortic stenosis, is indicated for patients with high or prohibitive surgical risk. Studies with this new treatment strategy use risk scores as criteria for inclusion and there are few studies that use such tools as predictors of risk. The risk scores, after due validation in their relevant populations, are combined with clinical practice (individualization of conduct in the definition of the conduct to be adopted in the clinical practice of valvular heart disease.

  19. Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology

    Energy Technology Data Exchange (ETDEWEB)

    Boesen, Lars; Mikines, Kari [Herlev University Hospital, Department of Urology, Herlev (Denmark); Chabanova, Elizaveta; Loegager, Vibeke; Thomsen, Henrik S. [Herlev University Hospital, Department of Radiology, Herlev (Denmark); Balslev, Ingegerd [Herlev University Hospital, Department of Pathology, Herlev (Denmark)

    2015-06-01

    To evaluate the diagnostic performance of preoperative multiparametric MRI with extracapsular extension (ECE) risk-scoring in the assessment of prostate cancer tumour stage (T-stage) and prediction of ECE at final pathology. Eighty-seven patients with clinically localised prostate cancer scheduled for radical prostatectomy were prospectively enrolled. Multiparametric MRI was performed prior to prostatectomy, and evaluated according to the ESUR MR prostate guidelines by two different readers. An MRI clinical T-stage (cT{sub MRI}), an ECE risk score, and suspicion of ECE based on tumour characteristics and personal opinion were assigned. Histopathological prostatectomy results were standard reference. Histopathology and cT{sub MRI} showed a spearman rho correlation of 0.658 (p < 0.001) and a weighted kappa = 0.585 [CI 0.44;0.73](reader A). ECE was present in 31/87 (36 %) patients. ECE risk-scoring showed an AUC of 0.65-0.86 on ROC-curve for both readers, with sensitivity and specificity of 81 % and 78 % at best cutoff level (reader A), respectively. When tumour characteristics were influenced by personal opinion, the sensitivity and specificity for prediction of ECE changed to 61 %-74 % and 77 %-88 % for the readers, respectively. Multiparametric MRI with ECE risk-scoring is an accurate diagnostic technique in determining prostate cancer clinical tumour stage and ECE at final pathology. (orig.)

  20. Prostate cancer staging with extracapsular extension risk scoring using multiparametric MRI: a correlation with histopathology

    International Nuclear Information System (INIS)

    To evaluate the diagnostic performance of preoperative multiparametric MRI with extracapsular extension (ECE) risk-scoring in the assessment of prostate cancer tumour stage (T-stage) and prediction of ECE at final pathology. Eighty-seven patients with clinically localised prostate cancer scheduled for radical prostatectomy were prospectively enrolled. Multiparametric MRI was performed prior to prostatectomy, and evaluated according to the ESUR MR prostate guidelines by two different readers. An MRI clinical T-stage (cTMRI), an ECE risk score, and suspicion of ECE based on tumour characteristics and personal opinion were assigned. Histopathological prostatectomy results were standard reference. Histopathology and cTMRI showed a spearman rho correlation of 0.658 (p < 0.001) and a weighted kappa = 0.585 [CI 0.44;0.73](reader A). ECE was present in 31/87 (36 %) patients. ECE risk-scoring showed an AUC of 0.65-0.86 on ROC-curve for both readers, with sensitivity and specificity of 81 % and 78 % at best cutoff level (reader A), respectively. When tumour characteristics were influenced by personal opinion, the sensitivity and specificity for prediction of ECE changed to 61 %-74 % and 77 %-88 % for the readers, respectively. Multiparametric MRI with ECE risk-scoring is an accurate diagnostic technique in determining prostate cancer clinical tumour stage and ECE at final pathology. (orig.)

  1. The Impact of SIM on FCAT Reading Scores of Special Education and At-Risk Students

    Science.gov (United States)

    Matyo-Cepero, Jude

    2013-01-01

    The purpose of this study was to determine if special education and at-risk students educated exclusively in a school-within-a-school setting showed improved high-stakes standardized reading test scores after learning the strategic instruction model (SIM) inference strategy. This study was focused on four groups of eighth-grade students attending…

  2. Diagnostic value of coronary artery calcium scoring in low-intermediate risk patients evaluated in the emergency department for acute coronary syndrome.

    Science.gov (United States)

    Fernandez-Friera, Leticia; Garcia-Alvarez, Ana; Bagheriannejad-Esfahani, Fatemeh; Malick, Waqas; Mirelis, Jesus G; Sawit, Simonette T; Fuster, Valentin; Sanz, Javier; Garcia, Mario J; Hermann, Luke K

    2011-01-01

    Early and accurate triage of patients with possible ischemic chest pain remains challenging in the emergency department because current risk stratification techniques have significant cost and limited availability. The aim of this study was to determine the diagnostic value of the coronary artery calcium score (CACS) for the detection of obstructive coronary artery disease (CAD) in low- to intermediate-risk patients evaluated in the emergency department for suspected acute coronary syndromes. A total of 225 patients presenting to the emergency department with acute chest pain and Thrombolysis In Myocardial Infarction (TIMI) scores <4 who underwent non-contrast- and contrast-enhanced coronary computed tomographic angiography were included. CACS was calculated from the noncontrast scan using the Agatston method. The prevalence of obstructive CAD (defined from the contrast scan as ? 50% maximal reduction in luminal diameter in any segment) was 9% and increased significantly with higher scores (p <0.01 for trend). CACS of 0 were observed in 133 patients (59%), of whom only 2 (1.5%) had obstructive CAD. The diagnostic accuracy of CACS to detect obstructive CAD was good, with an area under the receiver-operating characteristic curve of 0.88 and a negative predictive value of 99% for a CACS of 0. In a multivariate model, CACS was independently associated with obstructive CAD (odds ratio 7.01, p = 0.02) and provided additional diagnostic value over traditional CAD risk factors. In conclusion, CACS appears to be an effective initial tool for risk stratification of low- to intermediate-risk patients with possible acute coronary syndromes, on the basis of its high negative predictive value and additive diagnostic value. PMID:21146680

  3. Association of Cardiovascular Risk Using Nonlinear Heart Rate Variability Measures with the Framingham Risk Score in a Rural Population

    Directory of Open Access Journals (Sweden)

    HerbertFJelinek

    2013-07-01

    Full Text Available Cardiovascular risk can be calculated using the Framingham cardiovascular disease (CVD risk score and provides a risk stratification from mild to very high CVD risk percentage over 10 years. This equation represents a complex interaction between age, gender, cholesterol status, blood pressure, diabetes status and smoking. Heart rate variability (HRV is a measure of how the autonomic nervous system modulates the heart rate. HRV measures are sensitive to age, gender, disease status such as diabetes and hypertension and processes leading to atherosclerosis. We investigated whether HRV measures are a suitable, simple, noninvasive alternative to differentiate between the four main Framingham associated CVD risk categories. In this study we applied the tone-entropy (T-E algorithm and complex correlation measure (CCM for analysis of heart rate variability obtained from 20 minute ECG recordings and correlated the HRV score with the stratification results using the Framingham risk equation. Both entropy and CCM had significant analysis of variance (ANOVA results (F172, 3 = 9.51; <0.0001. Bonferroni post hoc analysis indicated a significant difference between mild, high and very high cardiac risk groups applying tone-entropy (p<0.01. CCM detected a difference in temporal dynamics of the RR intervals between the mild and very high CVD risk groups (p<0.01. Our results indicate a good agreement between the T-E and CCM algorithm and the Framingham CVD risk score, suggesting that this algorithm may be of use for initial screening of cardiovascular risk as it is noninvasive, economical and easy to use in clinical practice.

  4. Levothyroxine Substitution in Patients with Subclinical Hypothyroidism and the Risk of Myocardial Infarction and Mortality

    DEFF Research Database (Denmark)

    Andersen, Mette Nygaard; Olsen, Anne-Marie Schjerning

    2015-01-01

    BACKGROUND: Subclinical hypothyroidism is associated with a number of cardiovascular risk factors, yet only limited data exist on long-term outcome of levothyroxine treatment of this condition with respect to hard end-points. The aim of this retrospective cohort study was to determine effects of levothyroxine treatment on myocardial infarction (MI), cardiovascular death and all-cause mortality, in patients with subclinical hypothyroidism. METHODS AND RESULTS: Primary care patients aged 18 years and older that underwent thyroid function tests between 2000 and 2009 were enrolled. Participants were identified by individual-level linkage of nationwide registers. Patients with subclinical hypothyroidism at baseline were included in the study. Exclusion criteria included a history of thyroid disease, related medication or medication affecting thyroid function. The total cohort comprised 628,953 patients of which 12,212 (1.9%) had subclinical hypothyroidism (mean age 55.2 [SD ± 18.8] years; 79.8% female). Within the first six months 2,483 (20.3%) patients claimed a prescription for levothyroxine. During a median follow-up of 5.0 (IQR: 5.2) years, 358 MI's and 1,566 (12.8%) deaths were observed. Out of these, 766 of the deaths were cardiovascular related. No beneficial effects were found in levothyroxine treated patients on MI (IRR 1.08 [95% CI: 0.81 to 1.44]), cardiovascular death (IRR 1.02 [95% CI: 0.83 to 1.25]) or all-cause mortality (IRR 1.03 [95% CI: 0.90 to 1.19]), except in patients under the age of 65 years (IRR 0.63 [95% CI: 0.40 to 0.99]). CONCLUSION: Levothyroxine substitution in subclinical hypothyroid patients does not indicate an association with lower mortality or decreased risk of MI.

  5. Risk reduction of brain infarction during carotid endarterectomy or stenting using sonolysis - Prospective randomized study pilot data

    Science.gov (United States)

    Kuliha, Martin; Školoudík, David; Martin Roubec, Martin; Herzig, Roman; Procházka, Václav; Jonszta, Tomáš; Kraj?a, Jan; Czerný, Dan; Hrbá?, Tomáš; Otáhal, David; Langová, Kate?ina

    2012-11-01

    Sonolysis is a new therapeutic option for the acceleration of arterial recanalization. The aim of this study was to confirm risk reduction of brain infarction during endarterectomy (CEA) and stenting (CAS) of the internal carotid artery (ICA) using sonolysis with continuous transcranial Doppler (TCD) monitoring by diagnostic 2 MHz probe, additional interest was to assess impact of new brain ischemic lesions on cognitive functions. Methods: All consecutive patients 1/ with ICA stenosis >70%, 2/ indicated to CEA or CAS, 3/ with signed informed consent, were enrolled to the prospective study during 17 months. Patients were randomized into 2 groups: Group 1 with sonolysis during intervention and Group 2 without sonolysis. Neurological examination, assessment of cognitive functions and brain magnetic resonance imaging (MRI) were performed before and 24 hours after intervention in all patients. Occurrence of new brain infarctions (including infarctions >0.5 cm3), and the results of Mini-Mental State Examination, Clock Drawing and Verbal Fluency tests were statistically evaluated using T-test. Results: 97 patients were included into the study. Out of the 47 patients randomized to sonolysis group (Group 1) 25 underwent CEA (Group 1a) and 22 CAS (Group 1b). Out of the 50 patients randomized to control group (Group 2), 22 underwent CEA (Group 2a) and 28 CAS (Group 2b). New ischemic brain infarctions on follow up MRI were found in 14 (29.8%) patients in Group 1-4 (16.0%) in Group 1a and 10 (45.5%) in Group 1b. In Group 2, new ischemic brain infarctions were found in 18 (36.0%) patients-6 (27.3%) in Group 2a and 12 (42.9%) in Group 2b (p>0.05 in all cases). New ischemic brain infarctions >0.5 cm3 were found in 4 (8.5 %) patients in Group 1 and in 11 (22.0 %) patients in Group 2 (p= 0.017). No significant differences were found in cognitive tests results between subgroups (p>0.05 in all tests). Conclusion: Sonolysis seems to be effective in the prevention of large ischemic brain infarctions during CEA and CAS.

  6. Real-life evaluation of European and American high-risk strategies for primary prevention of cardiovascular disease in patients with first myocardial infarction

    DEFF Research Database (Denmark)

    Mortensen, Martin B; Falk, Erling

    2014-01-01

    OBJECTIVE: To determine the detection rate (sensitivity) of the high-risk strategy recommended in the European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE/UK) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines on cardiovascular disease (CVD) prevention. In particular, to evaluate the ability to ensure statin therapy to contemporary Europeans destined for a first myocardial infarction (MI). DESIGN: 393 consecutive statin-naïve, CVD-free patients without diabetes hospitalised for a first MI, 247 of whom were 40-75?years of age. We assumed they had undergone a health check the day before their MI and estimated the predicted risk. PRIMARY OUTCOME: Sensitivity of the risk-based eligibility for primary prevention with statins recommended by the guidelines. RESULTS: All recommended risk scores rank-ordered patients similarly, but the sensitivity of the cut point above which statin therapy should be considered differed substantially. In younger patients (age 40-60), 62% of men and 13% of women qualified for statin therapy by ACC/AHA criteria, compared with only 2% of men and no women using the ESC criteria recommended for most non-Eastern European countries. In those 60-75?years of age, the ACC/AHA guidelines captured all men and 85% of women, compared with 12% and 2%, respectively, using the new ESC guideline. This guideline restricted the eligibility for primary prevention with statins substantially by reclassifying many European countries from 'high-risk' to 'low-risk', whereas the eligibility was expanded in the ACC/AHA and the new NICE/UK guidelines by lowering the decision threshold. CONCLUSIONS: The 2012 ESC guidelines differ substantially from the 2013 ACC/AHA and 2014 NICE/UK guidelines in ability to secure statin therapy to those destined for a first MI. A great opportunity for primary prevention with statins remains unexploited in Europe.

  7. To Construct A Forecasting Model of the Anthropometric Chronic Disease Risk Factor Score

    Directory of Open Access Journals (Sweden)

    Yi-Chou Chuang

    2006-04-01

    Full Text Available Background: Many health indices have a relationship with anthropometric indices. Thisresearch attempts to provide a new measurement: a chronic disease risk factorscore built into the regression model. This new model will help peoplevisualize their health status and get multiple information during the processof the healthy examination.Methods: Data from 8,034 subjects were collected from the data bank of the HealthExamination Center in Chang Gung Memorial Hospital. Related anthropometricindices and biochemical factors were selected and used to construct aregression model. The anthropometric indices used were body mass index,waist hip ratio, waist hip area ratio, health index, waist leg ratio and trunk legratio. Biochemical data included blood pressure, glucose, triglyceride, cholesteroland uric acid, combined to form an anthropometric chronic diseaserisk factor score.Results: Subjects under 45 years of age had the highest chronic disease risk factorscore, and were selected to construct a regression model. The R-square ofthis model is 0.355; its predictive error is near 12%. After verification with atesting group, the regression model could be used to predict health status.Conclusion: The purpose of this study was to develop a new anthropometric chronic diseaserisk factor score by combining anthropometric indices and biochemicaldata. A multiple regression model was used to illustrate health status viaanthropometric chronic disease risk factor scores for the subjects participatingin the health examination. The results show that the chronic disease riskfactor score is useful for prescribing relevant medical treatment as well as forother research.

  8. A Bayesian Framework for Automated Cardiovascular Risk Scoring on Standard Lumbar Radiographs

    DEFF Research Database (Denmark)

    Petersen, Peter Kersten; Ganz, Melanie

    2011-01-01

    We present a fully automated framework for scoring a patients risk of cardiovascular disease (CVD) and mortality from a standard lateral radiograph of the lumbar aorta. The framework segments abdominal aortic calcifications for computing a CVD risk score and performs a survival analysis to validate the score. Since the aorta is invisible on X-ray images, its position is reasoned from (1) the shape and location of the lumbar vertebrae and (2) the location, shape, and orientation of potential calcifications. The proposed framework follows the principle of Bayesian inference, which has several advantages in the complex task of segmenting aortic calcifications. Bayesian modeling allows us to compute CVD risk scores conditioned on the seen calcifications by formulating distributions, dependencies, and constraints on the unknown parameters. We evaluate the framework on two datasets consisting of 351 and 462 standard lumbar radiographs, respectively. Promising results indicate that the framework has potential applications in diagnosis, treatment planning, and the study of drug effects related to CVD.

  9. Echocardiographic assessment of the impact of cardiovascular risk factors on left ventricular systolic function in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Vijay Kumar Verma

    2014-06-01

    Conclusion: Since the proportion of patients with LV systolic dysfunction in patients with AMI remains relatively high, LV systolic function variables such as LVEF and LVESV should be echocardiographically evaluated in all patients with AMI. Since the post-infarction LV systolic function remains the single most important determinant of survival, treatment of AMI patients should be aimed at limitation of infarct size and prevention of ventricular dilation. Moreover, cardiovascular risk factors such as diabetes mellitus and smoking have a significant impact on the likelihood of impairment of LV systolic function in patients with AMI and hence could influence long-term prognosis. [Int J Res Med Sci 2014; 2(3.000: 1101-1106

  10. Predicting coronary heart disease : from framingham risk score to ultrasound bioimaging

    DEFF Research Database (Denmark)

    Sillesen, Henrik; Fuster, Valentin

    2012-01-01

    Atherosclerosis is the leading cause of death and disabling disease. Whereas risk factors are well known and constitute therapeutic targets, they are not useful for prediction of risk of future myocardial infarction, stroke, or death. Therefore, methods to identify atherosclerosis itself have been tested and found useful (ie, coronary calcium detection by computed tomography scanning, reduction in ankle-brachial index, and ultrasound scanning of the carotid arteries). This review will focus on the latter technique. Detection of thickened carotid intima-media by ultrasound has been used in many large epidemiological studies, but although it has been found to be associated with increased risk of cardiovascular death, its clinical utility is limited. Detection of carotid plaque has, on the other hand, been found to be associated with a substantial risk of future events. Similarly, detection of plaque in the femoral arteries is associated with increased risk, and plaque in the femoral as well as carotid arteries predicts even higher risk. Furthermore, quantification of plaque size (plaque area), such as quantification of amount of coronary calcium on computed tomography scanning, improves predictability-the larger the plaques, the higher the risk. So far, studies using ultrasound all have been performed with 2-dimensional ultrasound imaging. Recently, 3-dimensional ultrasound imaging has been introduced, which allows for more accurate quantification of atherosclerosis. Small studies pioneering its use have indicated the utility of measuring changes in vessel-wall volume and plaque volume with respect to treatment effect. The High-Risk Plaque Initiative BioImage Study is currently investigating the predictive value of total carotid plaque volume with respect to prediction of future cardiovascular events. Mt Sinai J Med 79:654-663, 2012. © 2012 Mount Sinai School of Medicine.

  11. Early prediction of mortality in patients with acute myocardial infarction: a prospective study of clinical and radionuclide risk factors

    International Nuclear Information System (INIS)

    To examine the prognostic value of early radionuclide imaging in patients with transmural acute myocardial infarction, 222 patients in Killip class I and II were studied prospectively within 24 hours of the onset of symptoms. The 30-day mortality rate for the entire group was 11% (25 of 222). Univariate analysis indicated that an initial radionuclide left ventricular ejection fraction (EF) of less than 0.30 was associated with the greatest relative risk (RR = 6.6), although the percent of abnormally contracting regions (RR = 3.9) and thallium-201 defect index (RR = 3.3) were also significant risk factors. Stepwise logistic regression indicated that addition of EF resulted in the greatest improvement over the best clinical model (Killip class and chest radiographic findings) for the prediction of 30-day mortality (chi 2 improvement = 12.8, p less than 0.0005). Using the optimal model for prediction of mortality (EF and Killip class), a high-risk group with a 30-day mortality rate of 39% (90-day mortality 47%) and a low-risk group with a 30-day mortality rate of 3% (90-day mortality 4%) was identified. In clinically stable patients with transmural acute myocardial infarction, early assessment of EF in conjunction with clinical evaluation, is a valuable method for early identification of high-risk subsets

  12. Measurement of coronary sinus blood flow after first anterior myocardial infarction transthoracic echocardiography and its correlation with wall motion scoring lndex

    International Nuclear Information System (INIS)

    The aim of this study was measurement of Coronary Sinus Blood Flow (CSBF) and Coronary Sinus Velocity time Integral (CSVTI) via transthoracic echocardiography (TTE) in patients with acute myocardial infarction (AMI) in association with left ventricular ejection fraction (LVEF), wall motion scoring index (WMSI) and in-hospital mortality. Twenty patients with anterior AMI and 20 healthy individuals as controls, were studied in 6 months period in 2005 in Madani Heart Center in Tabriz, Iran. All received same drugs for AMI treatment (e.g. fibrinolytic). CSBF, CSVTI, WMSI and tissue Doppler imaging (TDI) data were obtained via TTE and compared between the two groups. Baseline variables were similar between two groups (p>0.05). CSBF in AMI group was 287.8 +- 128 ml/min and 415 +- 127 ml/min in control group (p=0.001). CSVTI was significantly lower in AMI group than control group (11.16 +- 2.85 and 17.56 +- 2.72 mm, respectively; p = 0.003). There was significant correlation between CSBF and LVEF (r = 0.52, p= 0.01), WMSI (r -0.77, p = 0.0001) and in-hospital mortality (r=0.58 p= 0.03), also between CSVTI and LVEF (r = 0.85, p = 0.0001), WMSI (r = -0.57, p = 0.0009) and in hospital-mortality rate (r = 0.69, p = 0.02). CSBF and CSVTI had good correlation with TDI findings: Em (peak early diastolic velocity in the myocardium) and Sm (peak systolic velocity in the myocardium). Our study demonstrated good correlation between measured CSBF and CSVTI by 2D, Doppler TTE and LVEF, WF and CSVTI by 2D, Doppler TTE and LVEF, WMSI, in-hospital mortality and also TDI findings; also we found that CSBF and CSVTI were independent predictors in AMI patients. (author)

  13. Puntaje de detección de riesgo nutricional para mortalidad en pacientes críticamente enfermos: NSRR: Nutritional Score Risk Research / Nutritional score risk for mortality in critically ill patients: NSRR: Nutritional Score Risk Research

    Scientific Electronic Library Online (English)

    A. M., Marín Ramírez; C., Rendon; E., Valencia.

    2008-10-01

    Full Text Available Objetivo: El objetivo principal del estudio fue la validación de un puntaje en la valoración nutricional al momento de llegar a la Unidad de Cuidados Intensivos (UCI) con o sin enfermedad previa, con el fin de establecer riesgos nutricionales de muerte desde el ingreso. Diseño: Se realizó un estudio [...] descriptivo, prospectivo, observacional de carácter transversal de abril del 2004 a diciembre del 2006. Ámbito: El estudio fue realizado en UCI. Pacientes y participantes: Para el estudio se lograron encuestar 228 pacientes. Las encuestas eran realizadas al familiar cercano que vivía con el paciente, en aquel momento que el familiar mostrar no convivencia con el paciente y/o desconocimiento de su patrón de ingesta de alimentos durante el diario la encuesta era descartada. Se seleccionaron al azar con patologías críticas (sepsis, trauma, pacientes neurocríticos, pacientes médicos, obstétricas críticas, etc.) en dos unidades de cuidados intensivos. Intervenciones: Interrogatorio a familiares. Variables de interés: El puntaje escogido fue el Nutritional Score Risk (NSR) el cual es elaborado para pacientes mayores de 65 años, puntaje que es ahora modificado para ser utilizado en las unidades de cuidados intensivos en forma práctica, viable, rápida, clara y útil en la obtención de resultados. Resultados: Nuestro estudio demostró que las alteraciones del NSR se pueden observar en todas las edades, establecido por no haber una correlación directa entre la edad y el NSR encontrado (r = 0,15, p = 0,018), además se encontró que el sufrir enfermedades crónicas que alteren las condiciones de ingesta alimentaria adecuada es un parámetro aislado significativo para incrementar la probabilidad de muerte al ingreso a la UCI (p = 0,002). Conclusiones: El NSR mostró que pacientes con un puntaje alto al ingresar por alguna patología aguda se encuentran en riesgo nutricional de morir. Abstract in english Aim: The aim of our study has been applying a nutritional score risk to mortality in a group of patients who are in the Intensive Care Unit with or without previous disease. Setting: Patients and interventions: a prospective randomized study is designed. Place: At the intensive care units. Patients: [...] 228 admitted patients since april 2004 to december 2006 were included. The surveys were filled by the near relative who lived with the patient and/or ignorance of its pattern of food ingestion during the newspaper the survey was discarded. Critically ill patients were selected at random with pathologies (neurocritical, sepsis, trauma, patients, obstetrics critics, etc.) in 2 units of adult intensive cares. Interventions: Dialogue with the families. Variables: The selected nutritional score (NSR) which is elaborated for greater patients of 65 years now is modifid to be used in intensive care unit, it is a questionnaire that can be very useful in the detection of initial nutritional risk of the critically ill patients. Results: Our study demonstrated that the alterations of the NSR can be observed in all ages, established by not having a direct correlation between the age and the found NSR (r = 0,15, p = 0,018). This supports the concept of use of the NSR in the adult ages that are admitted in the intensive care unit. In addition, was found that suffering chronic diseases that alter the conditions of ingestion if would feed suitable is an isolated parameter significant to increase the death probability if the patient is in the ICU (p =0,002). Conclusion: Patients with a high NSR at admittion to the intensive care unit for acute pathology are under risk to mortality by nutritional risk.

  14. Puntaje de detección de riesgo nutricional para mortalidad en pacientes críticamente enfermos: NSRR: Nutritional Score Risk Research Nutritional score risk for mortality in critically ill patients: NSRR: Nutritional Score Risk Research

    Directory of Open Access Journals (Sweden)

    A. M. Marín Ramírez

    2008-10-01

    Full Text Available Objetivo: El objetivo principal del estudio fue la validación de un puntaje en la valoración nutricional al momento de llegar a la Unidad de Cuidados Intensivos (UCI con o sin enfermedad previa, con el fin de establecer riesgos nutricionales de muerte desde el ingreso. Diseño: Se realizó un estudio descriptivo, prospectivo, observacional de carácter transversal de abril del 2004 a diciembre del 2006. Ámbito: El estudio fue realizado en UCI. Pacientes y participantes: Para el estudio se lograron encuestar 228 pacientes. Las encuestas eran realizadas al familiar cercano que vivía con el paciente, en aquel momento que el familiar mostrar no convivencia con el paciente y/o desconocimiento de su patrón de ingesta de alimentos durante el diario la encuesta era descartada. Se seleccionaron al azar con patologías críticas (sepsis, trauma, pacientes neurocríticos, pacientes médicos, obstétricas críticas, etc. en dos unidades de cuidados intensivos. Intervenciones: Interrogatorio a familiares. Variables de interés: El puntaje escogido fue el Nutritional Score Risk (NSR el cual es elaborado para pacientes mayores de 65 años, puntaje que es ahora modificado para ser utilizado en las unidades de cuidados intensivos en forma práctica, viable, rápida, clara y útil en la obtención de resultados. Resultados: Nuestro estudio demostró que las alteraciones del NSR se pueden observar en todas las edades, establecido por no haber una correlación directa entre la edad y el NSR encontrado (r = 0,15, p = 0,018, además se encontró que el sufrir enfermedades crónicas que alteren las condiciones de ingesta alimentaria adecuada es un parámetro aislado significativo para incrementar la probabilidad de muerte al ingreso a la UCI (p = 0,002. Conclusiones: El NSR mostró que pacientes con un puntaje alto al ingresar por alguna patología aguda se encuentran en riesgo nutricional de morir.Aim: The aim of our study has been applying a nutritional score risk to mortality in a group of patients who are in the Intensive Care Unit with or without previous disease. Setting: Patients and interventions: a prospective randomized study is designed. Place: At the intensive care units. Patients: 228 admitted patients since april 2004 to december 2006 were included. The surveys were filled by the near relative who lived with the patient and/or ignorance of its pattern of food ingestion during the newspaper the survey was discarded. Critically ill patients were selected at random with pathologies (neurocritical, sepsis, trauma, patients, obstetrics critics, etc. in 2 units of adult intensive cares. Interventions: Dialogue with the families. Variables: The selected nutritional score (NSR which is elaborated for greater patients of 65 years now is modifid to be used in intensive care unit, it is a questionnaire that can be very useful in the detection of initial nutritional risk of the critically ill patients. Results: Our study demonstrated that the alterations of the NSR can be observed in all ages, established by not having a direct correlation between the age and the found NSR (r = 0,15, p = 0,018. This supports the concept of use of the NSR in the adult ages that are admitted in the intensive care unit. In addition, was found that suffering chronic diseases that alter the conditions of ingestion if would feed suitable is an isolated parameter significant to increase the death probability if the patient is in the ICU (p =0,002. Conclusion: Patients with a high NSR at admittion to the intensive care unit for acute pathology are under risk to mortality by nutritional risk.

  15. Prognostic score for predicting risk of dementia over 10 years while accounting for competing risk of death

    DEFF Research Database (Denmark)

    Jacqmin-Gadda, Hélène; Blanche, Paul

    2014-01-01

    Early detection of subjects at high risk of developing dementia is essential. By dealing with censoring and competing risk of death, we developed a score for predicting 10-year dementia risk by combining cognitive tests, and we assessed whether inclusion of cognitive change over the previous year increased its discrimination. Data came from the French prospective cohort study Personnes Agées QUID (PAQUID) and included 3,777 subjects aged 65 years or older (1988-1998). The combined prediction score was estimated by means of an illness-death model handling interval censoring and competing risk of death. Its predictive ability was measured using the receiver operating characteristic (ROC) curve, with 2 different definitions depending on the way subjects who died without a dementia diagnosis were considered. To account for right-censoring and interval censoring, we estimated the ROC curves by means of a weighting approach and a model-based imputation estimator. The combined score exhibited an area under the ROC curve (AUROC) of 0.81 for discriminating future demented subjects from subjects alive and nondemented 10 years later and an AUROC of 0.75 for discriminating future demented subjects from all other subjects (including deceased persons). Adjustment for cognitive change over the previous year did not improve prediction.

  16. Risk score modeling of multiple gene to gene interactions using aggregated-multifactor dimensionality reduction

    Directory of Open Access Journals (Sweden)

    Dai Hongying

    2013-01-01

    Full Text Available Abstract Background Multifactor Dimensionality Reduction (MDR has been widely applied to detect gene-gene (GxG interactions associated with complex diseases. Existing MDR methods summarize disease risk by a dichotomous predisposing model (high-risk/low-risk from one optimal GxG interaction, which does not take the accumulated effects from multiple GxG interactions into account. Results We propose an Aggregated-Multifactor Dimensionality Reduction (A-MDR method that exhaustively searches for and detects significant GxG interactions to generate an epistasis enriched gene network. An aggregated epistasis enriched risk score, which takes into account multiple GxG interactions simultaneously, replaces the dichotomous predisposing risk variable and provides higher resolution in the quantification of disease susceptibility. We evaluate this new A-MDR approach in a broad range of simulations. Also, we present the results of an application of the A-MDR method to a data set derived from Juvenile Idiopathic Arthritis patients treated with methotrexate (MTX that revealed several GxG interactions in the folate pathway that were associated with treatment response. The epistasis enriched risk score that pooled information from 82 significant GxG interactions distinguished MTX responders from non-responders with 82% accuracy. Conclusions The proposed A-MDR is innovative in the MDR framework to investigate aggregated effects among GxG interactions. New measures (pOR, pRR and pChi are proposed to detect multiple GxG interactions.

  17. Alimentary Habits, Physical Activity, and Framingham Global Risk Score in Metabolic Syndrome

    International Nuclear Information System (INIS)

    Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition. To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention. The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%). Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases

  18. Alimentary Habits, Physical Activity, and Framingham Global Risk Score in Metabolic Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Thays Soliman; Piovesan, Carla Haas; Gustavo, Andréia da Silva; Macagnan, Fabrício Edler; Bodanese, Luiz Carlos; Feoli, Ana Maria Pandolfo, E-mail: anamariafeoli@hotmail.com [Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS (Brazil)

    2014-04-15

    Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition. To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention. The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%). Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases.

  19. Predicting PTSD using the New York Risk Score with genotype data: potential clinical and research opportunities

    Directory of Open Access Journals (Sweden)

    Boscarino JA

    2013-04-01

    Full Text Available Joseph A Boscarino,1,2 H Lester Kirchner,3,4 Stuart N Hoffman,5 Porat M Erlich1,4 1Center for Health Research, Geisinger Clinic, Danville, 2Department of Psychiatry, Temple University School of Medicine, Philadelphia, 3Division of Medicine, Geisinger Clinic, Danville, 4Department of Medicine, Temple University School of Medicine, Philadelphia, 5Department of Neurology, Geisinger Clinic, Danville, PA, USA Background: We previously developed a post-traumatic stress disorder (PTSD screening instrument, ie, the New York PTSD Risk Score (NYPRS, that was effective in predicting PTSD. In the present study, we assessed a version of this risk score that also included genetic information. Methods: Utilizing diagnostic testing methods, we hierarchically examined different prediction variables identified in previous NYPRS research, including genetic risk-allele information, to assess lifetime and current PTSD status among a population of trauma-exposed adults. Results: We found that, in predicting lifetime PTSD, the area under the receiver operating characteristic curve (AUC for the Primary Care PTSD Screen alone was 0.865. When we added psychosocial predictors from the original NYPRS to the model, including depression, sleep disturbance, and a measure of health care access, the AUC increased to 0.902, which was a significant improvement (P = 0.0021. When genetic information was added in the form of a count of PTSD risk alleles located within FKBP, COMT, CHRNA5, and CRHR1 genetic loci (coded 0–6, the AUC increased to 0.920, which was also a significant improvement (P = 0.0178. The results for current PTSD were similar. In the final model for current PTSD with the psychosocial risk factors included, genotype resulted in a prediction weight of 17 for each risk allele present, indicating that a person with six risk alleles or more would receive a PTSD risk score of 17 × 6 = 102, the highest risk score for any of the predictors studied. Conclusion: Genetic information added to the NYPRS helped improve the accuracy of prediction results for a screening instrument that already had high AUC test results. This improvement was achieved by increasing PTSD prediction specificity. Further research validation is advised. Keywords: post-traumatic stress disorder, psychological trauma, diagnostic screening, test development, genotype, single nucleotide polymorphism

  20. Attributable risks for acute myocardial infarction in four countries of Latin America

    Directory of Open Access Journals (Sweden)

    M. Ciruzzi

    2003-12-01

    Full Text Available This multicenter case control study investigated, in four countries of America, the proportions of acute myocardial infarction (AMI attributable to cholesterol, smoking, hypertension, body mass index, diabetes and family history of coronary heart disease (attributable risks, AR. AR were estimated using information from 1060 cases of AMI and 1071 controls from Argentina, 323 cases of AMI and 314 controls from Cuba, 200 cases of AMI and 200 controls from Mexico and 266 cases of AMI and 264 controls from Venezuela. AR were obtained from the prevalence of coronary risk factors in the cases and the corresponding Odds Ratio (OR derived through appropriate multivariate models. The AR for AMI observed for hypercholesterolaemia were the following: Venezuela 27%, Mexico 3%, Cuba 30% and Argentina 36%; for diabetes: Venezuela 10%, Mexico 15%, Cuba 5% and Argentina 7% and for body mass index: Venezuela 12%, Mexico 3%, Cuba 19% and Argentina 17%. The same risk factor may have a different attributable risk in different populations. Together, hypercholesterolaemia, hypertension, smoking, diabetes, body mass index and family history of coronary heart disease accounted for 76% of all cases of AMI in Venezuela, 70% in Mexico, 81% in Cuba and 79% in Argentina. The knowledge of attributable risks could have important implications for public health strategies, especially in those countries with limited health care resources.Este estudio caso-control y multicéntrico, investigó en cuatro países de América, la proporción de casos de infarto agudo de miocardio (IAM atribuidos al colesterol, tabaquismo, hipertensión, índice de masa corporal e historia familiar de enfermedad coronaria (riesgo atribuible, RA. Los RA fueron estimados a partir de la información de 1060 casos de IAM y 1071 controles de Argentina, 323 casos de IAM y 314 controles de Cuba, 200 casos de IAM y 200 controles de México y 266 casos de IAM y 264 controles de Venezuela. Los RA fueron obtenidos a partir de la prevalencia de los factores de riesgo coronario en los casos y sus correspondientes Odds Ratios (OR obtenidos luego de un análisis multivariado. Los RA para IAM observados para hipercolesterolemia fueron los siguientes: Venezuela 27%, México 3%, Cuba 30% y Argentina 36%; para diabetes: Venezuela 10%, México 15%, Cuba 5% y Argentina 7% y para índice de masa corporal: Venezuela 12%, México 3%, Cuba 19% y Argentina 17%. El mismo factor de riesgo tendría diferentes RA en diferentes poblaciones. Juntos el colesterol sérico, el tabaquismo, la hipertensión, el índice de masa corporal y la historia familiar de enfermedad coronaria fueron responsables del 76% de todos los casos de IAM en Venezuela, 70% en México, 81% en Cuba y 79% en Argentina. El conocimiento del RA tendría importantes implicancias en las estrategias de salud pública, especialmente en aquellos países con limitados recursos sanitarios.

  1. Attributable risks for acute myocardial infarction in four countries of Latin America

    Scientific Electronic Library Online (English)

    M., Ciruzzi; H., Schargrodsky; P., Pramparo; E., Rivas Estany; L., Rodriguez Naude; R., De la Noval Garcia; S., Gaxiola Cazarez; E., Meaney; A., Nass; B., Finizola; L., Castillo.

    2003-12-01

    Full Text Available Este estudio caso-control y multicéntrico, investigó en cuatro países de América, la proporción de casos de infarto agudo de miocardio (IAM) atribuidos al colesterol, tabaquismo, hipertensión, índice de masa corporal e historia familiar de enfermedad coronaria (riesgo atribuible, RA). Los RA fueron [...] estimados a partir de la información de 1060 casos de IAM y 1071 controles de Argentina, 323 casos de IAM y 314 controles de Cuba, 200 casos de IAM y 200 controles de México y 266 casos de IAM y 264 controles de Venezuela. Los RA fueron obtenidos a partir de la prevalencia de los factores de riesgo coronario en los casos y sus correspondientes Odds Ratios (OR) obtenidos luego de un análisis multivariado. Los RA para IAM observados para hipercolesterolemia fueron los siguientes: Venezuela 27%, México 3%, Cuba 30% y Argentina 36%; para diabetes: Venezuela 10%, México 15%, Cuba 5% y Argentina 7% y para índice de masa corporal: Venezuela 12%, México 3%, Cuba 19% y Argentina 17%. El mismo factor de riesgo tendría diferentes RA en diferentes poblaciones. Juntos el colesterol sérico, el tabaquismo, la hipertensión, el índice de masa corporal y la historia familiar de enfermedad coronaria fueron responsables del 76% de todos los casos de IAM en Venezuela, 70% en México, 81% en Cuba y 79% en Argentina. El conocimiento del RA tendría importantes implicancias en las estrategias de salud pública, especialmente en aquellos países con limitados recursos sanitarios. Abstract in english This multicenter case control study investigated, in four countries of America, the proportions of acute myocardial infarction (AMI) attributable to cholesterol, smoking, hypertension, body mass index, diabetes and family history of coronary heart disease (attributable risks, AR). AR were estimated [...] using information from 1060 cases of AMI and 1071 controls from Argentina, 323 cases of AMI and 314 controls from Cuba, 200 cases of AMI and 200 controls from Mexico and 266 cases of AMI and 264 controls from Venezuela. AR were obtained from the prevalence of coronary risk factors in the cases and the corresponding Odds Ratio (OR) derived through appropriate multivariate models. The AR for AMI observed for hypercholesterolaemia were the following: Venezuela 27%, Mexico 3%, Cuba 30% and Argentina 36%; for diabetes: Venezuela 10%, Mexico 15%, Cuba 5% and Argentina 7% and for body mass index: Venezuela 12%, Mexico 3%, Cuba 19% and Argentina 17%. The same risk factor may have a different attributable risk in different populations. Together, hypercholesterolaemia, hypertension, smoking, diabetes, body mass index and family history of coronary heart disease accounted for 76% of all cases of AMI in Venezuela, 70% in Mexico, 81% in Cuba and 79% in Argentina. The knowledge of attributable risks could have important implications for public health strategies, especially in those countries with limited health care resources.

  2. A score to predict short-term risk of COPD exacerbations (SCOPEX)

    Science.gov (United States)

    Make, Barry J; Eriksson, Göran; Calverley, Peter M; Jenkins, Christine R; Postma, Dirkje S; Peterson, Stefan; Östlund, Ollie; Anzueto, Antonio

    2015-01-01

    Background There is no clinically useful score to predict chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to derive this by analyzing data from three existing COPD clinical trials of budesonide/formoterol, formoterol, or placebo in patients with moderate-to-very-severe COPD and a history of exacerbations in the previous year. Methods Predictive variables were selected using Cox regression for time to first severe COPD exacerbation. We determined absolute risk estimates for an exacerbation by identifying variables in a binomial model, adjusting for observation time, study, and treatment. The model was further reduced to clinically useful variables and the final regression coefficients scaled to obtain risk scores of 0–100 to predict an exacerbation within 6 months. Receiver operating characteristic (ROC) curves and the corresponding C-index were used to investigate the discriminatory properties of predictive variables. Results The best predictors of an exacerbation in the next 6 months were more COPD maintenance medications prior to the trial, higher mean daily reliever use, more exacerbations during the previous year, lower forced expiratory volume in 1 second/forced vital capacity ratio, and female sex. Using these risk variables, we developed a score to predict short-term (6-month) risk of COPD exacerbations (SCOPEX). Budesonide/formoterol reduced future exacerbation risk more than formoterol or as-needed short-acting ?2-agonist (salbutamol). Conclusion SCOPEX incorporates easily identifiable patient characteristics and can be readily applied in clinical practice to target therapy to reduce COPD exacerbations in patients at the highest risk. PMID:25670896

  3. A risk score development for diabetic retinopathy screening in Isfahan-Iran

    OpenAIRE

    Sayed Mohsen Hosseini; Maracy, M. R.; Amini, M.

    2009-01-01

    • BACKGROUND: The purpose of this study was to develop a simple risk score as screening tool for retinopathy in type II diabetic patients.
    • METHODS: A cross-sectional study was carried out recruiting 3734  atients with type II diabetes in an outpatient clinic in Isfahan ndocrinology and Metabolism Research Center (IEMRC), Iran. The logistic regression was used as a model to predict diabetic...

    • Predicting survival in heart failure : a risk score based on 39 372 patients from 30 studies

      DEFF Research Database (Denmark)

      Pocock, Stuart J; Ariti, Cono A

      2012-01-01

      AimsUsing a large international database from multiple cohort studies, the aim is to create a generalizable easily used risk score for mortality in patients with heart failure (HF).Methods and resultsThe MAGGIC meta-analysis includes individual data on 39 372 patients with HF, both reduced and preserved left-ventricular ejection fraction (EF), from 30 cohort studies, six of which were clinical trials. 40.2% of patients died during a median follow-up of 2.5 years. Using multivariable piecewise Poisson regression methods with stepwise variable selection, a final model included 13 highly significant independent predictors of mortality in the following order of predictive strength: age, lower EF, NYHA class, serum creatinine, diabetes, not prescribed beta-blocker, lower systolic BP, lower body mass, time since diagnosis, current smoker, chronic obstructive pulmonary disease, male gender, and not prescribed ACE-inhibitor or angiotensin-receptor blockers. In preserved EF, age was more predictive and systolic BP wasless predictive of mortality than in reduced EF. Conversion into an easy-to-use integer risk score identified a very marked gradient in risk, with 3-year mortality rates of 10 and 70% in the bottom quintile and top decile of risk, respectively.ConclusionIn patients with HF of both reduced and preserved EF, the influences of readily available predictors of mortality can be quantified in an integer score accessible by an easy-to-use website www.heartfailurerisk.org. The score has the potential for widespread implementation in a clinical setting.

    • Diet-Quality Scores and the Risk of Type 2 Diabetes in Men

      OpenAIRE

      Koning, Lawrence; Chiuve, Stephanie Elizabeth; Fung, Teresa Toiyee; Willett, Walter C.; Rimm, Eric B.; Hu, Frank B.

      2011-01-01

      Objective: To 1) compare associations of diet-quality scores, which were inversely associated with cardiovascular disease, with incident type 2 diabetes and 2) test for differences in absolute-risk reduction across various strata. Research Design and Methods: Men from the Health Professionals Follow-Up Study, who were initially free of type 2 diabetes, cardiovascular disease, or cancer (n = 41,615), were followed for \\(\\leq 20\\) years. The Healthy Eating Index (HEI) 2005, the alternative HEI ...

    • Limitations of the Parsonnet score for measuring risk stratified mortality in the north west of England

      OpenAIRE

      Wynne-jones, K.; Jackson, M.; Grotte, G.; Bridgewater, B.; North, W.

      2000-01-01

      OBJECTIVE—To study the use of the Parsonnet score to predict mortality following adult cardiac surgery.?DESIGN—Prospective study.?SETTING—All centres performing adult cardiac surgery in the north west of England.?SUBJECTS—8210 patients undergoing surgery between April 1997 and March 1999.?MAIN OUTCOME MEASURES—Risk factors and in-hospital mortality were recorded according to agreed definitions. Ten per cent of cases from each centre were selected at random for validation. A...

    • Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

      Directory of Open Access Journals (Sweden)

      Bates Tom

      2007-06-01

      Full Text Available Abstract Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.

    • Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction

      Energy Technology Data Exchange (ETDEWEB)

      Nguyen, Paul L., E-mail: pnguyen@LROC.harvard.edu [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Chen, Ming-Hui [Department of Statistics, University of Connecticut, Storrs, CT (United States); Beckman, Joshua A. [Department of Cardiology, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Beard, Clair J.; Martin, Neil E. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Choueiri, Toni K. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); Hu, Jim C. [Division of Urologic Surgery, Brigham and Women' s/Faulkner Hospital, Harvard Medical School, Boston, MA (United States); Hoffman, Karen E. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Dosoretz, Daniel E. [21st Century Oncology, Fort Myers, FL (United States); Moran, Brian J. [Chicago Prostate Center, Westmont, IL (United States); Salenius, Sharon A. [21st Century Oncology, Fort Myers, FL (United States); Braccioforte, Michelle H. [Chicago Prostate Center, Westmont, IL (United States); Kantoff, Philip W. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); D' Amico, Anthony V. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Ennis, Ronald D. [Department of Radiation Oncology, St. Luke' s-Roosevelt and Beth Israel Hospitals, Continuum Cancer Centers of New York, Albert Einstein College of Medicine, New York, NY (Israel)

      2012-03-15

      Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c-T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32-2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17-5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13-2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96-2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

    • Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction

      International Nuclear Information System (INIS)

      Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c–T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32–2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17–5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13–2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96–2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patientause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

    • Distinction of salvaged and infarcted myocardium within the ischaemic area-at-risk with T2 mapping

      DEFF Research Database (Denmark)

      Hammer-Hansen, Sophia; Ugander, Martin

      2014-01-01

      AIM: Area-at-risk (AAR) measurements often rely on T2-weighted images, but subtle differences in T2 may be overlooked with this method. To determine the differences in oedema between salvaged and infarcted myocardium, we performed quantitative T2 mapping of the AAR. We also aimed to determine the impact of reperfusion time on T2 in the AAR. METHODS: Twenty-two dogs underwent 2 h of coronary occlusion followed by 4 or 48 h of reperfusion before cardiac magnetic resonance imaging at 1.5 T. Late gadolinium enhancement images were used to define the infarcted, salvaged, and remote myocardium. T2 values from T2 maps and signal intensities on T2-weighted images were measured in the corresponding areas. RESULTS: At both imaging time points, the T2 of the salvaged myocardium was longer than of remote (66.0 ± 6.9 vs. 51.4 ± 3.5 ms, P < 0.001 at 4 h, and 56.7 ± 7.3 vs. 48.1 ± 3.5 ms, P < 0.001 at 48 h). The T2 was also longer in the infarcted myocardium compared with remote at both 4 and 48 h (71.4 ± 7.6 ms, P < 0.01vs. salvage and 64.0 ± 6.9 ms, P = 0.03 vs. salvage, both P < 0.001 vs. remote). The increase in T2 in the salvaged myocardium compared with remote was greater after 4 h than after 48 h (14.7 ± 5.6 vs. 8.7 ± 5.1 ms, P = 0.02). CONCLUSIONS: T2 relaxation parameters are different in the infarcted and salvaged myocardium, and both are significantly longer than remote. Furthermore, the magnitude of increase in T2 was less in the salvaged myocardium after longer reperfusion, indicating partial resolution of oedema in the first 48 h after reperfusion.

    • Impact of Acute Hyperglycemia on Myocardial Infarct Size, Area at Risk, and Salvage in Patients With STEMI and the Association With Exenatide Treatment : Results From a Randomized Study

      DEFF Research Database (Denmark)

      LØnborg, Jacob; Vejlstrup, Niels

      2014-01-01

      Hyperglycemia upon hospital admission in patients with ST-segment elevation myocardial infarction (STEMI) occurs frequently and is associated with adverse outcomes. It is, however, unsettled as to whether an elevated blood glucose level is the cause or consequence of increased myocardial damage. In addition, whether the cardioprotective effect of exenatide, a glucose-lowering drug, is dependent on hyperglycemia remains unknown. The objectives of this substudy were to evaluate the association between hyperglycemia and infarct size, myocardial salvage, and area at risk, and to assess the interaction between exenatide and hyperglycemia. A total of 210 STEMI patients were randomized to receive intravenous exenatide or placebo before percutaneous coronary intervention. Hyperglycemia was associated with larger area at risk and infarct size compared with patients with normoglycemia, but the salvage index and infarct size adjusting for area at risk did not differ between the groups. Treatment with exenatide resulted in increased salvage index both among patients with normoglycemia and hyperglycemia. Thus, we conclude that the association between hyperglycemia upon hospital admission and infarct size in STEMI patients is a consequence of a larger myocardial area at risk but not of a reduction in myocardial salvage. Also, cardioprotection by exenatide treatment is independent of glucose levels at hospital admission. Thus, hyperglycemia does not influence the effect of the reperfusion treatment but rather represents a surrogate marker for the severity of risk and injury to the myocardium.

    • Duration of clopidogrel treatment and risk of mortality and recurrent myocardial infarction among 11 680 patients with myocardial infarction treated with percutaneous coronary intervention: a cohort study

      Directory of Open Access Journals (Sweden)

      Køber Lars

      2010-01-01

      Full Text Available Abstract Background The optimal duration of clopidogrel treatment after percutaneous coronary intervention (PCI is unclear. We studied the risk of death or recurrent myocardial infarction (MI in relation to 6- and 12-months clopidogrel treatment among MI patients treated with PCI. Methods Using nationwide registers of hospitalizations and drug dispensing from pharmacies we identified 11 680 patients admitted with MI, treated with PCI and clopidogrel. Clopidogrel treatment was categorized in a 6-months and a 12-months regimen. Rates of death, recurrent MI or a combination of both were analyzed by the Kaplan Meier method and Cox proportional hazards models. Bleedings were compared between treatment regimens. Results The Kaplan Meier analysis indicated no benefit of the 12-months regimen compared with the 6-months in all endpoints. The Cox proportional hazards analysis confirmed these findings with hazard ratios for the 12-months regimen (the 6-months regimen used as reference for the composite endpoint of 1.01 (confidence intervals 0.81-1.26 and 1.24 (confidence intervals 0.95-1.62 for Day 0-179 and Day 180-540 after discharge. Bleedings occurred in 3.5% and 4.1% of the patients in the 6-months and 12-months regimen (p = 0.06. Conclusions We found comparable rates of death and recurrent MI in patients treated with 6- and 12-months' clopidogrel. The potential benefit of prolonged clopidogrel treatment in a real-life setting remains uncertain.

    • Impact of Primary Gleason Grade on Risk Stratification for Gleason Score 7 Prostate Cancers

      International Nuclear Information System (INIS)

      Purpose: To evaluate the primary Gleason grade (GG) in Gleason score (GS) 7 prostate cancers for risk of non-organ-confined disease with the goal of optimizing radiotherapy treatment option counseling. Methods: One thousand three hundred thirty-three patients with pathologic GS7 were identified in the Duke Prostate Center research database. Clinical factors including age, race, clinical stage, prostate-specific antigen at diagnosis, and pathologic stage were obtained. Data were stratified by prostate-specific antigen and clinical stage at diagnosis into adapted D’Amico risk groups. Univariate and multivariate analyses were performed evaluating for association of primary GG with pathologic outcome. Results: Nine hundred seventy-nine patients had primary GG3 and 354 had GG4. On univariate analyses, GG4 was associated with an increased risk of non-organ-confined disease. On multivariate analysis, GG4 was independently associated with seminal vesicle invasion (SVI) but not extracapsular extension. Patients with otherwise low-risk disease and primary GG3 had a very low risk of SVI (4%). Conclusions: Primary GG4 in GS7 cancers is associated with increased risk of SVI compared with primary GG3. Otherwise low-risk patients with GS 3+4 have a very low risk of SVI and may be candidates for prostate-only radiotherapy modalities.

    • Association between certain foods and risk of acute myocardial infarction in women.

      OpenAIRE

      Gramenzi, A.; Gentile, A.; Fasoli, M.; Negri, E.; Parazzini, F.; La Vecchia, C.

      1990-01-01

      STUDY OBJECTIVE--To examine the relation between selected foods and acute myocardial infarction in women. DESIGN--Case-control study conducted over five years. SETTING--30 Hospitals with coronary care units in northern Italy. SUBJECTS--287 Women who had had an acute myocardial infarction (median age 49, range 22-69 years) and 649 controls with acute disorders unrelated to ischaemic heart disease (median age 50, range 21-69 years) admitted to hospital during 1983-9. MAIN OUTCOME MEASURES--Freq...

    • Risk factors for myocardial infarction case fatality and stroke case fatality in type 2 diabetes: UKPDS 66.

      OpenAIRE

      Stevens, Rj; Coleman, Rl; Adler, Ai; Stratton, Im; Matthews, Dr; Holman, Rr

      2004-01-01

      OBJECTIVE: Patients with diabetes have a higher case fatality rate in myocardial infarction (MI) or stroke than those without diabetes: that is, MI and stroke are more often fatal if diabetes is present. We investigated whether the risk of MI or stroke being fatal in type 2 diabetes can be estimated using information available around the time diabetes is diagnosed. RESEARCH DESIGN AND METHODS: Analyses were based on 674 cases of MI (351 fatal) that occurred in 597 of 5,102 U.K. Prospective Di...

    • [Outpatient coronary groups. 1st experiences with high-risk infarct patients after a year's model experiment].

      Science.gov (United States)

      Buchbinder, W; Gocke, H; Ilker, H G; Stein, G

      1981-04-01

      One year's experience with patients after myocardial infarction with low physical capacity (high risk-patients) and their participation in coronary clubs. After satisfactory results have been recorded with coronary training-groups at Hamburg first results can be reported from a trial with a coronary exercising-group at the patient's community. Patients after myocardial infarction with low physical capacity (high risk-patients) have participated regularly in coronary club meetings. One year's observation with medical controls showed no hazards from special adapted exercises combined with health education. Cardiac complications did not occur. The exercise program aims on increasing coordination and flexibility; general aerobic endurance is not to be improved. Thus a better and more economical functioning of the cardiovascular system is reached; life quality is improved. Further propagation of the coronary exercising-program is recommended if the described precautions are observed. This way many coronary patients could benefit also from long-time participation in comprehensive care in coronary clubs, which were up to now excluded from coronary training groups because of high risk. PMID:7227944

    • A simple score for estimating the long-term risk of fracture in patients with multiple sclerosis

      DEFF Research Database (Denmark)

      Bazelier, M. T.; van Staa, T. P.

      2012-01-01

      Objective: To derive a simple score for estimating the long-term risk of osteoporotic and hip fracture in individual patients with MS. Methods: Using the UK General Practice Research Database linked to the National Hospital Registry (1997-2008), we identified patients with incident MS (n = 5,494). They were matched 1:6 by year of birth, sex, and practice with patients without MS (control subjects). Cox proportional hazards models were used to calculate the long-term risk of osteoporotic and hip fracture. We fitted the regression model with general and specific risk factors, and the final Cox model was converted into integer risk scores. Results: In comparison with the FRAX calculator, our risk score contains several new risk factors that have been linked with fracture, which include MS, use of antidepressants, use of anticonvulsants, history of falling, and history of fatigue. We estimated the 5- and 10-year risks of osteoporotic and hip fracture in relation to the risk score. The C-statistic was moderate (0.67) for the prediction of osteoporotic fracture and excellent (0.89) for the prediction of hip fracture. Conclusion: This is the first clinical risk score for fracture risk estimation involving MS as a risk factor. Neurology (R) 2012;79:922-928

    • Developing and Validating a Risk Score for Lower-Extremity Amputation in Patients Hospitalized for a Diabetic Foot Infection

      Science.gov (United States)

      Lipsky, Benjamin A.; Weigelt, John A.; Sun, Xiaowu; Johannes, Richard S.; Derby, Karen G.; Tabak, Ying P.

      2011-01-01

      OBJECTIVE Diabetic foot infection is the predominant predisposing factor to nontraumatic lower-extremity amputation (LEA), but few studies have investigated which specific risk factors are most associated with LEA. We sought to develop and validate a risk score to aid in the early identification of patients hospitalized for diabetic foot infection who are at highest risk of LEA. RESEARCH DESIGN AND METHODS Using a large, clinical research database (CareFusion), we identified patients hospitalized at 97 hospitals in the U.S. between 2003 and 2007 for culture-documented diabetic foot infection. Candidate risk factors for LEA included demographic data, clinical presentation, chronic diseases, and recent previous hospitalization. We fit a logistic regression model using 75% of the population and converted the model coefficients to a numeric risk score. We then validated the score using the remaining 25% of patients. RESULTS Among 3,018 eligible patients, 21.4% underwent an LEA. The risk factors most highly associated with LEA (P 11,000 per mm3. The model showed good discrimination (c-statistic 0.76) and excellent calibration (Hosmer-Lemeshow, P = 0.63). The risk score stratified patients into five groups, demonstrating a graded relation to LEA risk (P < 0.0001). The LEA rates (derivation and validation cohorts) were 0% for patients with a score of 0 and ~50% for those with a score of ?21. CONCLUSIONS Using a large, hospitalized population, we developed and validated a risk score that seems to accurately stratify the risk of LEA among patients hospitalized for a diabetic foot infection. This score may help to identify high-risk patients upon admission. PMID:21680728

    • Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

      Energy Technology Data Exchange (ETDEWEB)

      Garofallo, Silvia Bueno; Machado, Daniel Pinheiro; Rodrigues, Clarissa Garcia; Bordim, Odemir Jr.; Kalil, Renato A. K.; Portal, Vera Lúcia, E-mail: veraportal.pesquisa@gmail.com [Post-Graduation Program in Health Sciences: Cardiology, Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

      2014-06-15

      The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe. To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP). Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP. Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus. Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery.

    • Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

      International Nuclear Information System (INIS)

      The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe. To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP). Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP. Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus. Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery

  1. Cardiovascular Risk Factors in Normolipidemic Acute Myocardial Infarct Patients on Admission – Do Dietary Fruits and Vegetables Offer Any Benefits?

    Directory of Open Access Journals (Sweden)

    Arun Kumar

    2010-10-01

    Full Text Available Background: Myocardial Infarction (MI is a leading cause of death in India. Whether dietary vitamins could reduce risk of cardiovascular disease among Indians is still not clear and very few studies have addressed the association between dietary vitamin acting as an antioxidant or pro-oxidant and its effect on risk reduction or aggravation in normolipidemic AMI patients. Objective: The goal of the current study was to address the association between dietary vitamin and cardiovascular risk in normolipidemic acute myocardial infarct patients compared with healthy controls. Design: Dietary intake of vitamins was assessed by 131 food frequency questionnaire items in both AMI patients and age/sex-matched controls. The associated changes in risk factors due to antioxidant vitamins intake was also assessed in normolipidemic acute myocardial patients and was compared with controls. Results: Dietary intake of vitamin A, B1, B2, B3 was significantly higher in AMI patients compared to healthy controls but the intake of vitamin C was significantly higher in controls compared to AMI patients. Even though the vitamins intake was higher in patients, the associated cardiovascular risk factors were not reduced compared to controls. The total cholesterol, LDL-c, TAG were significantly higher (p<0.001 in AMI patients except HDL-c which was significantly higher (p<0.001 in controls. The endogenous antioxidants were found to be significantly lowered in patients compared to controls in spite of higher vitamin intake. Similarly the enzymatic antioxidants were also significantly lowered in patients. The mean serum Lipoprotein (a malondialdehyde (MDA and conjugated diene (CD levels in patients were significantly elevated compared with controls. The levels of caeruloplasmin, C-reactive protein, fibrinogen, ischemia-modified albumin were significantly higher but arylesterase activities were lowered in patients. Conclusion: Diets rich in vegetables and fruits do not seem to reduce the cardiovascular risk in normolipidemic AMI patients among Indians and Sri Lankans.

  2. Determinants of Excess Genetic Risk of Acute Myocardial Infarction - A Matched Case-Control Study.

    Czech Academy of Sciences Publication Activity Database

    Valenta, Zden?k; Mazura, Ivan; Kolá?, M.; Feglarová, Petra; Peleška, Jan; Tome?ková, Marie; Kalina, Jan; Slovák, Dalibor; Zvárová, Jana

    2012-01-01

    Ro?. 8, ?. 1 (2012), s. 34-43. ISSN 1801-5603 R&D Projects: GA MŠk(CZ) 1M06014 Institutional support: RVO:67985807 Keywords : genome-wide association study * gene expression * myocardial infarction * genetic predisposition * predictive modeling Subject RIV: BB - Applied Statistics, Operational Research http://www.ejbi.org/img/ejbi/2012/1/Valenta_en.pdf

  3. A risk-scoring scheme for suicide attempts among patients with bipolar disorder in a Thai patient cohort

    Directory of Open Access Journals (Sweden)

    Patumanond J

    2012-04-01

    Full Text Available Chidchanok Ruengorn1,2, Kittipong Sanichwankul3, Wirat Niwatananun2, Suwat Mahatnirunkul3, Wanida Pumpaisalchai3, Jayanton Patumanond11Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 3Suanprung Psychiatric Hospital, Chiang Mai, ThailandBackground: In Thailand, risk factors associated with suicide attempts in bipolar disorder (BD are rarely investigated, nor has a specific risk-scoring scheme to assist in the identification of BD patients at risk for attempting suicide been proposed.Objective: To develop a simple risk-scoring scheme to identify patients with BD who may be at risk for attempting suicide.Methods: Medical files of 489 patients diagnosed with BD at Suanprung Psychiatric Hospital between October 2006 and May 2009 were reviewed. Cases included BD patients hospitalized due to attempted suicide (n = 58, and seven controls were selected (per suicide case among BD in- and out-patients who did not attempt suicide, with patients being visited the same day or within 1 week of case study (n = 431. Broad sociodemographic and clinical factors were gathered and analyzed using multivariate logistic regression, to obtain a set of risk factors. Scores for each indicator were weighted, assigned, and summed to create a total risk score, which was divided into low, moderate, and high-risk suicide attempt groups.Results: Six statistically significant indicators associated with suicide attempts were included in the risk-scoring scheme: depression, psychotic symptom(s, number of previous suicide attempts, stressful life event(s, medication adherence, and BD treatment years. A total risk score (possible range -1.5 to 11.5 explained an 88.6% probability of suicide attempts based on the receiver operating characteristic (ROC analysis. Likelihood ratios of suicide attempts with low risk scores (below 2.5, moderate risk scores (2.5–8.0, and high risk scores (above 8.0 were 0.11 (95% CI 0.04–0.32, 1.72 (95% CI 1.41–2.10, and 19.0 (95% CI 6.17–58.16, respectively.Conclusion: The proposed risk-scoring scheme is BD-specific, comprising six key indicators for simple, routine assessment and classification of patients to three risk groups. Further validation is required before adopting this scheme in other clinical settings.Keywords: bipolar disorder, mood disorders, suicidal behavior, screening tool

  4. Relationship between sarcopenic obesity and cardiovascular disease risk as estimated by the Framingham risk score.

    Science.gov (United States)

    Kim, Jeong-Hyeon; Cho, Jung Jin; Park, Yong Soon

    2015-03-01

    This study was conducted to assess the association between sarcopenic obesity and cardiovascular disease (CVD) risk in Korean adults (n=3,320; ?40 yr) who participated in the 5th Korean National Health and Nutrition Examination Survey in 2010. The appendicular skeletal muscle mass divided by body weight was calculated for each participant; participants with values mass index ?25 kg/m(2)) and sarcopenic status. Individuals' 10-yr CVD risk was determined using the Framingham risk model. The sarcopenic obese group had more participants (43.8% men, 14.6% women) with a high risk of CVD (?20%). The sarcopenic obese group was associated with an increased 10-yr CVD risk than the non-sarcopenic, non-obese group (odds ratio [OR], 2.49; 95% confidence interval [CI], 1.53-4.06, P<0.001 in men; OR, 1.87; 95% CI, 1.02-3.41, P=0.041 in women). Sarcopenic non-obese and non-sarcopenic obese subjects were not associated with an increased 10-yr CVD risk. Sarcopenic obesity, but not non-sarcopenic obesity, was closely associated with an increased CVD risk in Korean adults. PMID:25729248

  5. Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenectomy

    Science.gov (United States)

    Chen, Ji-Ye; Feng, Jian; Wang, Xian-Qiang; Cai, Shou-Wang; Dong, Jia-Hong; Chen, Yong-Liang

    2015-01-01

    AIM: To establish a scoring system to predict clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). METHODS: The clinical records of 921 consecutive patients who underwent PD between 2008 and 2013 were reviewed retrospectively. Postoperative pancreatic fistula (POPF) was defined and classified by the international study group of pancreatic fistula (ISGPF). We used a logistic regression model to determine the independent risk factors of CR-POPF and developed a scoring system based on the regression coefficient of the logistic regression model. The optimal cut-off value to divide the risk strata was determined by the Youden index. The patients were divided into two groups (low risk and high risk). The independent sample t test was used to detect differences in the means of drain amylase on postoperative day (POD) 1, 2 and 3. The optimal cut-off level of the drain amylase to distinguish CR-POPF from non-clinical POPF in the two risk strata groups was determined using the receiver operating characteristic (ROC) curves. RESULTS: Grade A POPF occurred in 106 (11.5%) patients, grade B occurred in 57 (6.2%) patients, and grade C occurred in 32 (3.5%) patients. A predictive scoring system for CR-POPF (0-6 points) was constructed using the following four factors: 1 point for each body mass index ? 28 [odds ratio (OR) = 3.86; 95% confidence interval (CI): 1.92-7.75, P = 0.00], soft gland texture (OR = 4.50; 95%CI, 2.53-7.98, P = 0.00), and the difference between the blood loss and transfusion in operation ? 800 mL (OR = 3.45; 95%CI, 1.92-7.75, P = 0.00); and from 0 points for a 5 mm or greater duct diameter to 3 points for a less than 2 mm duct (OR = 8.97; 95%CI: 3.70-21.77, P = 0.00). The ROC curve showed that the area under the curve of this score was 0.812. A score of 3 points was suggested to be the best cut-off value (Youden index = 0.485). In the low risk group, a drain amylase level ? 3600 U/L on POD3 could distinguish CR-POPF from non-clinical POPF (the sensitivity and specificity were 75% and 85%, respectively). In the high risk group, the best cut-off was a drain amylase level of 1600 (the sensitivity and specificity were 77 and 63%, respectively). CONCLUSION: A 6-point scoring system accurately predicted the occurrence of CR-POPF. In addition, a drain amylase level on POD3 might be a predictor of this complication. PMID:26019457

  6. Risk evaluation for the development of cervical intraepithelial neoplasia: development and validation of risk-scoring schemes.

    Science.gov (United States)

    Lee, Chien-Hung; Peng, Chiung-Yu; Li, Ruei-Nian; Chen, Yu-Chieh; Tsai, Hsiu-Ting; Hung, Yu-Hsiu; Chan, Te-Fu; Huang, Hsiao-Ling; Lai, Tai-Cheng; Wu, Ming-Tsang

    2015-01-15

    Cervical cancer screening guidelines do not comprehensively define what constitutes high risk. This study developed and validated simple risk-scoring schemes to improve Papanicolaou smear screening for women at high risk. Four cumulative risk score (CRS) schemes were derived respectively for the development of cervical intraepithelial neoplasia grade 1 (CIN1) and grade 2 or worse (CIN2+) using community-based case-control data (n = 1523). By calculating the area under the receiver operating characteristic (AU-ROC) curve, these schemes were validated in a Papanicolaou smear follow-up cohort (n = 967) and a hospital-based cytology screening population (n = 217). A high DNA load of high-risk human papillomavirus (HR-HPV) was the main predictor for CIN1 and CIN2+, although age, married status combined with the number of sexual partners, active and passive smoking and age at sexual debut also affected associated lesions. In the training set, only the HPV-testing-contained CIN2+ CRS scheme presented an excellent discrimination for identifying CIN2+ (AU-ROC = 0.866). Using a CRS cutoff value of 4 to identify CIN2+, the sensitivity and specificity of predicting CIN2+ for the 3- and 5-year follow-ups were 100% and 90.8%, and 83.3% and 90.4%, respectively, in the validation cohort. In the hospital-based validation population, the CRS scheme showed comparable discrimination for CIN2+ detection (sensitivity 88.2% and specificity 84.6%). Women with CRS ? 4 had a 5.4% and 9.1% of 3- and 5-year cumulative incidence, respectively, and a 40.5-fold hazard ratio of developing CIN2+. In conclusion, combined with HR-HPV testing and verified risk factors, a simple CRS scheme could effectively improve the implementation of CIN2+ screening. PMID:24841989

  7. Risk stratification in cardiovascular disease primary prevention - scoring systems, novel markers, and imaging techniques.

    LENUS (Irish Health Repository)

    Zannad, Faiez

    2012-04-01

    The aim of this paper is to review and discuss current methods of risk stratification for cardiovascular disease (CVD) prevention, emerging biomarkers, and imaging techniques, and their relative merits and limitations. This report is based on discussions that took place among experts in the area during a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy in September 2009. Classical risk factors such as blood pressure and low-density lipoprotein cholesterol levels remain the cornerstone of risk estimation in primary prevention but their use as a guide to management is limited by several factors: (i) thresholds for drug treatment vary with the available evidence for cost-effectiveness and benefit-to-risk ratios; (ii) assessment may be imprecise; (iii) residual risk may remain, even with effective control of dyslipidemia and hypertension. Novel measures include C-reactive protein, lipoprotein-associated phospholipase A(2) , genetic markers, and markers of subclinical organ damage, for which there are varying levels of evidence. High-resolution ultrasound and magnetic resonance imaging to assess carotid atherosclerotic lesions have potential but require further validation, standardization, and proof of clinical usefulness in the general population. In conclusion, classical risk scoring systems are available and inexpensive but have a number of limitations. Novel risk markers and imaging techniques may have a place in drug development and clinical trial design. However, their additional value above and beyond classical risk factors has yet to be determined for risk-guided therapy in CVD prevention.

  8. GENETIC ADDICTION RISK SCORE (GARS ANALYSIS: EXPLORATORY DEVELOPMENT OF POLYMORPHIC RISK ALLELES IN POLY-DRUG ADDICTED MALES

    Directory of Open Access Journals (Sweden)

    Kenneth Blum et al

    2010-07-01

    Full Text Available There is a need to classify patients at genetic risk for drug seeking behavior prior to or upon entry to residential and or non-residential chemical dependency programs. We have determined based on a literature review, that there are seven risk alleles associated with six candidate genes that were studied in this patient population of recovering poly-drug abusers. To determine risk severity of these 26 patients we calculated the percentage of prevalence of the risk alleles and provided a severity score based on percentage of these alleles. Subjects carry the following risk alleles: DRD2=A1; SLC6A3 (DAT =10R; DRD4=3R or 7R; 5HTTlRP = L or LA; MAO= 3R; and COMT=G. As depicted in table 2 low severity (LS = 1-36%; Moderate Severity =37-50%, and High severity = 51-100%. We studied two distinct ethnic populations group 1 consisted of 16 male Caucasian psycho stimulant addicts and group 2 consisted of 10 Chinese heroin addicted males. Based on this model the 16 subjects tested have at least one risk allele or 100%. Out of the 16 subjects we found 50% (8 HS; 31% (5 MS; and 19% LS (3 subjects. These scores are then converted to a fraction and then represented as a Genetic Addiction Risk Score (GARS whereby we found the average GARS to be: 0.28 low severity, 0.44 moderate severity and 0.58 high severity respectively. Therefore, using this GARS we found that 81% of the patients were at moderate to high risk for addictive behavior. Of particular interest we found that 56% of the subjects carried the DRD2 A1 allele (9/16. Out of the 9 Chinese heroin addicts [one patient not genotyped] (group 2 we found 11% (1 HS; 56% (5 MS; and 33% LS (3 subjects. These scores are then converted to a fraction and then represented as GARS whereby we found the average GARS to be: 0.28 Low Severity; 0.43 moderate severity and 0.54 high severity respectively. Therefore, using GARS we found that 67% of the patients were at moderate to high risk for addictive behavior. Of particular interest we found that 56% of the subjects carried the DRD2 A1 allele (5/9 similar to group 1. Statistical analysis revealed that the groups did not differ in terms of overall severity (67 vs. 81% in these two distinct populations. Combining these two independent study populations reveal that subjects entering a residential treatment facility for poly-drug abuse carry at least one risk allele (100%. We found 74% of the combined 25 subjects (Caucasian and Chinese had a moderate to high GARS. Confirmation of these exploratory results and development of mathematical predictive values of these risk alleles are necessary before any meaningful interpretation of these results are to be considered.

  9. Predictive and Incremental Validity of the Violence Risk Appraisal Guide Scores with Male and Female Jail Inmates

    Science.gov (United States)

    Hastings, Mark E.; Krishnan, Shilpa; Tangney, June P.; Stuewig, Jeffrey

    2011-01-01

    The present study examines the predictive and incremental validity of Violence Risk Appraisal Guide scores in a sample of 328 male and 145 female jail inmates held on felony charges. Significant gender differences were observed in VRAG item and total score means, as well as in correlations between the VRAG and concurrent measures of aggression.…

  10. External Validation of the Cancer of the Prostate Risk Assessment (CAPRA) Score in a Single-Surgeon Radical Prostatectomy Series

    Science.gov (United States)

    Loeb, Stacy; Carvalhal, Gustavo F.; Kan, Donghui; Desai, Angel; Catalona, William J.

    2011-01-01

    SUMMARY Objectives Prostate cancer clinical staging has significant limitations in the ability to accurately risk-stratify patients for prompt treatment or expectant management. The University of California San Francisco Cancer of the Prostate Risk Assessment (UCSF CAPRA) was recently described as a straightforward staging system that uses clinical variables to generate a score ranging from 0 to 10. Our objective was to perform an external validation of the CAPRA score as a predictor of 5-year progression-free survival (PFS) in a single-surgeon radical retropubic prostatectomy (RRP) series. Materials and Methods We examined the performance characteristics of the preoperative CAPRA score (0–10) to predict biochemical progression-free survival (PFS) in 990 men who underwent RRP by a single surgeon from 2003 to 2009. Results CAPRA scores were significantly associated with the risk of early biochemical progression in our series. For example, 5-year PFS was markedly different for scores at the extremes of 0 to 1 versus ?7 (95% vs. 40%, respectively). The concordance index was 0.764 for the prediction of biochemical progression using CAPRA scores in this cohort, which compares favorably with the concordance index of 0.66 in the original CaPSURE dataset. Conclusions Our results validate the UCSF-CAPRA score as a significant predictor of 5-year PFS in a single surgeon series. The CAPRA score is a simple preoperative tool that can be readily applied in clinical practice to help risk-stratify prostate cancer patients. PMID:20822930

  11. Individual patient risk stratification of high-risk neuroblastomas using a two-gene score suited for clinical use.

    Science.gov (United States)

    von Stedingk, Kristoffer; De Preter, Katleen; Vandesompele, Jo; Noguera, Rosa; Øra, Ingrid; Koster, Jan; Versteeg, Rogier; Påhlman, Sven; Lindgren, David; Axelson, Håkan

    2015-08-15

    Several gene expression-based prognostic signatures have been described in neuroblastoma, but none have successfully been applied in the clinic. Here we have developed a clinically applicable prognostic gene signature, both with regards to number of genes and analysis platform. Importantly, it does not require comparison between patients and is applicable amongst high-risk patients. The signature is based on a two-gene score (R-score) with prognostic power in high-stage tumours (stage 4 and/or MYCN-amplified diagnosed after 18 months of age). QPCR-based and array-based analyses of matched cDNAs confirmed cross platform (array-qPCR) transferability. We also defined a fixed cut-off value identifying prognostically differing subsets of high-risk patients on an individual patient basis. This gene expression signature independently contributes to the current neuroblastoma classification system, and if prospectively validated could provide further stratification of high-risk patients, and potential upfront identification of a group of patients that are in need of new/additional treatment regimens. PMID:25652004

  12. Discrepancy Between Clinician and Research Assistant in TIMI Score Calculation (TRIAGED CPU

    Directory of Open Access Journals (Sweden)

    Taylor, Brian T.

    2014-11-01

    Full Text Available Introduction: Several studies have attempted to demonstrate that the Thrombolysis in Myocardial Infarction (TIMI risk score has the ability to risk stratify emergency department (ED patients with potential acute coronary syndromes (ACS. Most of the studies we reviewed relied on trained research investigators to determine TIMI risk scores rather than ED providers functioning in their normal work capacity. We assessed whether TIMI risk scores obtained by ED providers in the setting of a busy ED differed from those obtained by trained research investigators. Methods: This was an ED-based prospective observational cohort study comparing TIMI scores obtained by 49 ED providers admitting patients to an ED chest pain unit (CPU to scores generated by a team of trained research investigators. We examined provider type, patient gender, and TIMI elements for their effects on TIMI risk score discrepancy. Results: Of the 501 adult patients enrolled in the study, 29.3% of TIMI risk scores determined by ED providers and trained research investigators were generated using identical TIMI risk score variables. In our low-risk population the majority of TIMI risk score differences were small; however, 12% of TIMI risk scores differed by two or more points. Conclusion: TIMI risk scores determined by ED providers in the setting of a busy ED frequently differ from scores generated by trained research investigators who complete them while not under the same pressure of an ED provider. [West J Emerg Med. 2015;16(1:24–33.

  13. A score to predict short-term risk of COPD exacerbations (SCOPEX

    Directory of Open Access Journals (Sweden)

    Make BJ

    2015-01-01

    Full Text Available Barry J Make,1 Göran Eriksson,2 Peter M Calverley,3 Christine R Jenkins,4 Dirkje S Postma,5 Stefan Peterson,6 Ollie Östlund,7 Antonio Anzueto8 1Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado Denver School of Medicine, Denver, CO, USA; 2Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden; 3Pulmonary and Rehabilitation Research Group, University Hospital Aintree, Liverpool, UK; 4George Institute for Global Health, The University of Sydney and Concord Clinical School, Woolcock Institute of Medical Research, Sydney, NSW, Australia; 5Department of Pulmonology, University of Groningen and GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands; 6StatMind AB, Lund, Sweden; 7Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden; 8Department of Pulmonary/Critical Care, University of Texas Health Sciences Center and South Texas Veterans Healthcare System, San Antonio, TX, USA Background: There is no clinically useful score to predict chronic obstructive pulmonary disease (COPD exacerbations. We aimed to derive this by analyzing data from three existing COPD clinical trials of budesonide/formoterol, formoterol, or placebo in patients with moderate-to-very-severe COPD and a history of exacerbations in the previous year. Methods: Predictive variables were selected using Cox regression for time to first severe COPD exacerbation. We determined absolute risk estimates for an exacerbation by identifying variables in a binomial model, adjusting for observation time, study, and treatment. The model was further reduced to clinically useful variables and the final regression coefficients scaled to obtain risk scores of 0–100 to predict an exacerbation within 6 months. Receiver operating characteristic (ROC curves and the corresponding C-index were used to investigate the discriminatory properties of predictive variables. Results: The best predictors of an exacerbation in the next 6 months were more COPD maintenance medications prior to the trial, higher mean daily reliever use, more exacerbations during the previous year, lower forced expiratory volume in 1 second/forced vital capacity ratio, and female sex. Using these risk variables, we developed a score to predict short-term (6-month risk of COPD exacerbations (SCOPEX. Budesonide/formoterol reduced future exacerbation risk more than formoterol or as-needed short-acting ß2-agonist (salbutamol. Conclusion: SCOPEX incorporates easily identifiable patient characteristics and can be readily applied in clinical practice to target therapy to reduce COPD exacerbations in patients at the highest risk. Keywords: chronic obstructive pulmonary disease, exacerbation, model, predictor, inhaled corticosteroids, bronchodilators 

  14. Update on prognostic factors in acromegaly: Is a risk score possible?

    Science.gov (United States)

    Fernandez-Rodriguez, E; Casanueva, F F; Bernabeu, I

    2015-06-01

    Certain clinical conditions and markers have recently been demonstrated to modify the natural history of acromegaly in affected patients. Thus, some clinical, histological, radiological and molecular factors are associated with more aggressive pituitary tumors that have higher biochemical activity, higher tumor volumes and decreased tumoral and biochemical responses to current therapies. However, these factors do not seem to have an equal influence on the prognosis of patients with acromegaly. We present a review of the factors that influence the clinical course of patients with acromegaly and propose a risk value for each factor that will allow prognostic scoring for affected patients by considering a combination of these factors. PMID:24858722

  15. High platelet volume and increased risk of myocardial infarction: 39,531 participants from the general population

    DEFF Research Database (Denmark)

    Klovaite, J; Benn, M

    2011-01-01

    BACKGROUND: Active platelets are large and contribute to development of myocardial infarction (MI). Platelet size is measured automatically as mean platelet volume (MPV) together with platelet count. OBJECTIVES: We tested the hypothesis that increased MPV is associated with risk of MI in the general population independent of known cardiovascular risk factors. METHODS: We examined 39,531 men and woman from the Danish general population (the Copenhagen General Population Study), of whom 1300 developed MI. RESULTS: After multifactorial adjustment for known cardiovascular risk factors, risk of MI was increased by 37% (95% CI, 18-59%) in the middle and 30% (12-52%) in the upper vs. the lower tertile of MPV. Compared with the 1st quintile of MPV, there was corresponding increased risk of MI of 13% (-7% to 39%), 35% (11-64%), 31% (8-59%) and 29% (6-57%) in the 2nd, 3rd, 4th and 5th quintile, respectively. Similar values for octiles were increases in MI risk of -3% (-25% to 26%), 15% (-10% to 46%), 31% (1-69%), 32% (5-68%), 31% (2-67%), 27% (-1% to 62%) and 26% (-1% to 61%), respectively, in the 2nd through to the 8th octile vs. the 1st octile of MPV. Use of antiplatelet therapy did not modify these risk estimates. Finally, in prospective, multifactorially adjusted analyses, risk of MI increased by 38% (8-75%) in individuals with MPV = 7.4 vs. < 7.4 fL. CONCLUSIONS: Increased MPV is associated with increased risk of MI independent of known cardiovascular risk factors.

  16. Risk of recurrent myocardial infarction with the concomitant use of clopidogrel and proton pump inhibitors.

    OpenAIRE

    Valkhoff, Vera E; T Jong, Geert W.; Van Soest, Eva Marianne; Ernst J Kuipers; Sturkenboom, Miriam C

    2010-01-01

    Abstract Background: The association between myocardial infarction (MI) and co-administration of PPIs and clopidogrel remains controversial. Aim: To quantify the association between concomitant use of PPIs and clopidogrel and occurrence of recurrent MI. Methods: We conducted a case-control study within a cohort of acute MI patients in PHARMO Record Linkage System (1999-2008). Cases were patients readmitted for MI. PPI exposure was categorized as current (3-1 days before MI), ...

  17. Limited clinical utility of a genetic risk score for the prediction of fracture risk in elderly subjects.

    Science.gov (United States)

    Eriksson, Joel; Evans, Daniel S; Nielson, Carrie M; Shen, Jian; Srikanth, Priya; Hochberg, Marc; McWeeney, Shannon; Cawthon, Peggy M; Wilmot, Beth; Zmuda, Joseph; Tranah, Greg; Mirel, Daniel B; Challa, Sashi; Mooney, Michael; Crenshaw, Andrew; Karlsson, Magnus; Mellström, Dan; Vandenput, Liesbeth; Orwoll, Eric; Ohlsson, Claes

    2015-01-01

    It is important to identify the patients at highest risk of fractures. A recent large-scale meta-analysis identified 63 autosomal single-nucleotide polymorphisms (SNPs) associated with bone mineral density (BMD), of which 16 were also associated with fracture risk. Based on these findings, two genetic risk scores (GRS63 and GRS16) were developed. Our aim was to determine the clinical usefulness of these GRSs for the prediction of BMD, BMD change, and fracture risk in elderly subjects. We studied two male (Osteoporotic Fractures in Men Study [MrOS] US, MrOS Sweden) and one female (Study of Osteoporotic Fractures [SOF]) large prospective cohorts of older subjects, looking at BMD, BMD change, and radiographically and/or medically confirmed incident fractures (8067 subjects, 2185 incident nonvertebral or vertebral fractures). GRS63 was associated with BMD (?3% of the variation explained) but not with BMD change. Both GRS63 and GRS16 were associated with fractures. After BMD adjustment, the effect sizes for these associations were substantially reduced. Similar results were found using an unweighted GRS63 and an unweighted GRS16 compared with those found using the corresponding weighted risk scores. Only minor improvements in C-statistics (AUC) for fractures were found when the GRSs were added to a base model (age, weight, and height), and no significant improvements in C-statistics were found when they were added to a model further adjusted for BMD. Net reclassification improvements with the addition of the GRSs to a base model were modest and substantially attenuated in BMD-adjusted models. GRS63 is associated with BMD, but not BMD change, suggesting that the genetic determinants of BMD differ from those of BMD change. When BMD is known, the clinical utility of the two GRSs for fracture prediction is limited in elderly subjects. PMID:25043339

  18. The effect of leisure-time physical activity on the risk of acute myocardial infarction depending on Body Mass Index: a population-based case-control study

    Directory of Open Access Journals (Sweden)

    Reuterwall Christina

    2006-12-01

    Full Text Available Abstract Background High body mass index (BMI and lack of physical activity have been recognized as important risk factors for coronary heart disease. The aim of the present study was to evaluate whether leisure-time physical activity compensates for the increased risk of acute myocardial infarction associated with overweight and obesity. Methods Data from the SHEEP (Stockholm Heart Epidemiology Program study were used. The SHEEP study is a large Swedish population-based case-control study, comprising 1204 male and 550 female cases, and 1538 male and 777 female controls, conducted in Stockholm County, Sweden, during the period 1992–1994. Odds ratios (OR, together with 95 % confidence intervals (95% CI, were calculated using unconditional logistic regression, as estimates of the relative risks. Results Regular leisure-time physical activity was associated with a decreased risk of myocardial infarction among lean, normal-weight and overweight subjects, but not among obese subjects. Obese (BMI ? 30 and physically active persons had an almost twofold risk of myocardial infarction, compared with normal-weight and sedentary persons (OR 1.85, 95% CI 1.07–3.18. The results were similar for men and women. Conclusion While regular leisure-time physical activity seems to provide protection against myocardial infarction among lean, normal-weight and overweight subjects, this does not appear to be the case in obese subjects.

  19. Ventricular arrhythmias and risk of death and acute myocardial infarction in apparently healthy subjects of age >or=55 years.

    DEFF Research Database (Denmark)

    Sajadieh, A; Nielsen, OW

    2006-01-01

    Increased ventricular ectopic activity and even more complex arrhythmias are not uncommon in subjects without apparent heart disease. However, their prognostic significance has been controversial and not updated in recent years. The prevalence and prognostic significance of different ventricular arrhythmias were studied in a cohort of middle-aged and elderly subjects without apparent heart disease. Six hundred seventy-eight men and women aged 55 to 75 years without a history of heart disease or stroke were included. Baseline examinations included physical examinations, fasting laboratory testing, and 48-hour ambulatory electrocardiographic monitoring. All patients were followed for up to 5 years. Combined events were defined as all-cause mortality or acute myocardial infarction. A cardiovascular event was defined as cardiovascular death or acute myocardial infarction. In total, 84% had 0 to 10 ventricular premature complexes (VPCs)/hour, 8% had 11 to 30 VPCs/hour, and 8% had >30 VPCs/hour; 10.8% had >or=1 runof >or=3 VPCs. Frequent VPCs (>or=30/hour) was a significant predictor of combined (hazard ratio 2.47, 95% confidence interval 1.29 to 4.68, p = 0.006) and cardiovascular (hazard ratio 2.85, 95% confidence interval 1.16 to 7.0, p = 0.023) event rates, after adjustment for conventional risk factors. Runs of >or=4 VPCs/day or >or=2 doublets/day were also associated with a poor prognosis, but only in the presence of frequent VPCs. The detection of a single VPC on standard electrocardiography was a significant predictor of frequent VPCs and an independent predictor of events (hazard ratio 2.6, 95% confidence interval 1.02 to 6.66, p = 0.045). In conclusion, apparently healthy, middle-aged and elderly subjects with frequent VPCs (>or=30/hour) have a poor prognosis. According to current guidelines, strict risk-factor modification and primary prevention are justified in these high-risk subjects.

  20. QT dispersion as a risk factor for sudden cardiac death and fatal myocardial infarction in a coronary risk population.

    OpenAIRE

    Ma?ntta?ri, M.; Oikarinen, L.; Manninen, V.; Viitasalo, M.

    1997-01-01

    OBJECTIVE: To test in a prospective study the hypothesis that increased QT dispersion in resting 12-lead ECG is a predictor of sudden cardiac death. DESIGN: A nested case-control study during a mean (SD) follow up time of 6.5 (2.8) years. SETTING: A prospective, placebo controlled, coronary prevention trial with gemfibrozil among dyslipidaemic middle aged men in primary (occupational) health care units: the Helsinki heart study. PATIENTS: 24 victims of fatal myocardial infarction, 48 victims ...

  1. A genetic risk score for hypertension associates with the risk of ischemic stroke in a Swedish case-control study.

    Science.gov (United States)

    Fava, Cristiano; Sjögren, Marketa; Olsson, Sandra; Lövkvist, Håkan; Jood, Katarina; Engström, Gunnar; Hedblad, Bo; Norrving, Bo; Jern, Christina; Lindgren, Arne; Melander, Olle

    2014-10-01

    Genetic risk scores (GRS), summing up the total effect of several single-nucleotide polymorphisms (SNPs) in genes associated with either coronary risk or cardiovascular risk factors, have been tested for association with ischemic stroke with conflicting results. Recently an association was found between a GRS based on 29 SNPs discovered by genome-wide association studies and hypertension. The aim of our study was to investigate the possible association of the same GRS with ischemic stroke on top of other 'traditional risk factors', also testing its potential improvement in indices of discrimination and reclassification, in a Swedish case-control study. Twenty-nine SNPs were genotyped in 3677 stroke cases and 2415 controls included in the Lund Stroke Register (LSR), the Malmö Diet and Cancer (MDC) study and the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). The analysis was conducted in the combined sample, and separately for the three studies. After adjustment for hypertension, diabetes mellitus and smoking habits, the GRS was associated with ischemic stroke in the combined sample (OR (95% CI) 1.086 (1.029-1.147) per SD increase in the GRS P=0.003) with similar trends in all three samples: LSR (1.050 (0.967-1.140); P=0.25), MDC (1.168 (1.060-1.288); P=0.002) and SAHLSIS (1.124 (0.997-1.267); P=0.055). Measures of risk discrimination and reclassification improved marginally using the GRS. A blood pressure GRS is independently associated with ischemic stroke risk in three Swedish case-control studies, however, the effect size is low and adds marginally to prediction of stroke on top of traditional risk factors including hypertension.European Journal of Human Genetics advance online publication, 8 October 2014; doi:10.1038/ejhg.2014.212. PMID:25293721

  2. Investigation of the genetic association between quantitative measures of psychosis and schizophrenia : a polygenic risk score analysis

    DEFF Research Database (Denmark)

    Derks, Eske M; Vorstman, Jacob A S

    2012-01-01

    The presence of subclinical levels of psychosis in the general population may imply that schizophrenia is the extreme expression of more or less continuously distributed traits in the population. In a previous study, we identified five quantitative measures of schizophrenia (positive, negative, disorganisation, mania, and depression scores). The aim of this study is to examine the association between a direct measure of genetic risk of schizophrenia and the five quantitative measures of psychosis. Estimates of the log of the odds ratios of case/control allelic association tests were obtained from the Psychiatric GWAS Consortium (PGC) (minus our sample) which included genome-wide genotype data of 8,690 schizophrenia cases and 11,831 controls. These data were used to calculate genetic risk scores in 314 schizophrenia cases and 148 controls from the Netherlands for whom genotype data and quantitative symptom scores were available. The genetic risk score of schizophrenia was significantly associated with case-control status (p

  3. Antipsychotics and risk of first-time hospitalization for myocardial infarction: a population-based case-control study

    DEFF Research Database (Denmark)

    Nakagawa, S; Pedersen, Lene

    2006-01-01

    Background. Use of antipsychotics has been linked with an adverse cardiovascular risk factor profile and an increased risk of dysrhythmia and sudden cardiac death. However, detailed data on the association between use of antipsychotics and development of atherosclerotic disease are limited. Objective. To examine risk of hospitalization for myocardial infarction (MI) amongst users of antipsychotics compared with non-users. Design and subjects. A population-based case-control study using data from hospital discharge registries in the counties of North Jutland, Viborg and Aarhus, Denmark, and the Danish Civil Registration System. We identified 21 377 cases of first-time hospitalization for MI and 106 885 sex- and age-matched non-MI population controls in the period 1992-2004. All prescriptions for antipsychotics filled prior to the date of admission for MI were retrieved from population-based prescription databases. We used conditional logistic regression to adjust for a wide range of covariates. Results. Current users of atypical [adjusted relative risk: 0.98, 95% confidence interval (CI): 0.88-1.09] and typical antipsychotics (adjusted relative risk: 0.99, 95% CI: 0.96-1.03) had no increased overall risk of being admitted to hospital for MI when compared with non-users of antipsychotics. These findings were consistent in all examined subgroups. Further, we found no association between the cumulative dose of antipsychotics and the risk of hospitalization for MI. Conclusion. These findings do not support the hypothesis that use of antipsychotics and in particular atypical antipsychotics is associated with increased risk of MI

  4. A Quantitative Climate-Match Score for Risk-Assessment Screening of Reptile and Amphibian Introductions

    Science.gov (United States)

    van Wilgen, Nicola J.; Roura-Pascual, Núria; Richardson, David M.

    2009-09-01

    Assessing climatic suitability provides a good preliminary estimate of the invasive potential of a species to inform risk assessment. We examined two approaches for bioclimatic modeling for 67 reptile and amphibian species introduced to California and Florida. First, we modeled the worldwide distribution of the biomes found in the introduced range to highlight similar areas worldwide from which invaders might arise. Second, we modeled potentially suitable environments for species based on climatic factors in their native ranges, using three sources of distribution data. Performance of the three datasets and both approaches were compared for each species. Climate match was positively correlated with species establishment success (maximum predicted suitability in the introduced range was more strongly correlated with establishment success than mean suitability). Data assembled from the Global Amphibian Assessment through NatureServe provided the most accurate models for amphibians, while ecoregion data compiled by the World Wide Fund for Nature yielded models which described reptile climatic suitability better than available point-locality data. We present three methods of assigning a climate-match score for use in risk assessment using both the mean and maximum climatic suitabilities. Managers may choose to use different methods depending on the stringency of the assessment and the available data, facilitating higher resolution and accuracy for herpetofaunal risk assessment. Climate-matching has inherent limitations and other factors pertaining to ecological interactions and life-history traits must also be considered for thorough risk assessment.

  5. A composite scoring of genotypes discriminates coronary heart disease risk beyond conventional risk factors in the Boston Puerto Rican Health Study

    Science.gov (United States)

    Background: Few studies have examined the usefulness of genetic scores to identify subjects at increased risk for coronary heart disease (CHD). Using a genetic predisposition score (GPS), integrating the additive associations of a set of single nucleotide polymorphisms (SNPs) with CHD, we examined t...

  6. Is the effect of job strain on myocardial infarction risk due to interaction between high psychological demands and low decision latitude? : Results from Stockholm Heart Epidemiology Program (SHEEP)

    DEFF Research Database (Denmark)

    Hallqvist, J; Diderichsen, Finn

    1998-01-01

    The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material is a population-based case-referent study having incident first events of myocardial infarction as outcome (SHEEP: Stockholm Heart Epidemiology Program). The analysis is restricted to males 45-64 yr of age with a more detailed analysis confined to those still working at inclusion. In total, 1047 cases and 1450 referents were included in the analysis. Exposure categories of job strain were formed from self reported questionnaire information. The results show that high demands and low decision latitude interact with a synergy index of 7.5 (95% C.I.: 1.8-30.6) providing empirical support for the core mechanism of the job strain model. Manual workers are more susceptible when exposed to job strain and its components and this increased susceptibility explains about 25-50% of the relative excess risk among manual workers. Low decision latitude may also, as a causal link, explain about 30% of the socioeconomic difference in risk of myocardial infarction. The distinction between the interaction and the causal link mechanisms identifies new etiologic questions and intervention alternatives. The specific causes of the increased susceptibility among manual workers to job strain and its components seem to be an interesting and important research question.

  7. Refined ambient PM2.5 exposure surrogates and the risk of myocardial infarction

    OpenAIRE

    Hodas, Natasha; Turpin, Barbara; Lunden, Melissa; Baxter, Lisa; O?zkaynak, Halu?k; Burke, Janet; Ohman-strickland, Pamela; Thevenet-morrison, Kelly; Rich, David Q.

    2013-01-01

    Using a case-crossover study design and conditional logistic regression, we compared the relative odds of transmural (full-wall) myocardial infarction (MI) calculated using exposure surrogates that account for human activity patterns and the indoor transport of ambient PM2.5 with those calculated using central-site PM2.5 concentrations to estimate exposure to PM2.5 of outdoor origin (exposure to ambient PM2.5). Because variability in human activity and indoor PM2.5 transport contributes expos...

  8. Cardiovascular risk prediction in the general population with use of suPAR, CRP, and Framingham Risk Score

    DEFF Research Database (Denmark)

    Lyngbæk, Stig; Marott, Jacob L

    2013-01-01

    BACKGROUND: The inflammatory biomarkers soluble urokinase plasminogen activator receptor (suPAR) and C-reactive protein (CRP) independently predict cardiovascular disease (CVD). The prognostic implications of suPAR and CRP combined with Framingham Risk Score (FRS) have not been determined. METHODS: From 1993 to 1994, baseline levels of suPAR and CRP were obtained from 2315 generally healthy Danish individuals (mean [SD] age: 53.9 [10.6] years) who were followed for the composite outcome of ischemic heart disease, stroke and CVD mortality. RESULTS: During a median follow-up of 12.7years, 302 events were recorded. After adjusting for FRS, women with suPAR levels in the highest tertile had a 1.74-fold (95% confidence interval [CI]: 1.08-2.81, p=0.027) and men a 2.09-fold (95% CI: 1.37-3.18, p20%) risk categories, respectively. This was reflected in a significant improvement of C statistics for men (p=0.034) and borderline significant for women (p=0.054), while the integrated discrimination improvement was highlysignificant (P?0.001) for both genders. CONCLUSIONS: suPAR provides prognostic information of CVD risk beyond FRS and improves risk prediction substantially when combined with CRP in this setting.

  9. Pain-to-hospital times, cardiovascular risk factors, and early intrahospital mortality in patients with acute myocardial infarction

    Science.gov (United States)

    Brkovi?, Eliana; Novak, Katarina; Puljak, Livia

    2015-01-01

    Background The aim of the study was to analyze the most recent trends in myocardial infarction (MI) care, the number of patients treated for MI and their outcomes, cardiovascular disease risk factors, and pain-to-hospital times in MI patients. Subjects and methods For 778 patients treated for acute MI at the Coronary Care Unit (CCU) of University Hospital Split, Croatia the following data were acquired: outcome during hospitalization (survived, deceased), cardiovascular risk factors (hypertension, diabetes, dyslipidemia, previous MI, smoking), and pain-to-CCU time. Results Among 778 patients treated for acute MI, there were 291 (37%) women and 487 (63%) men. Forty-five patients (6%) died during hospitalization, mostly due to cardiogenic shock. An association was found between early intrahospital mortality and the following risk factors: age >70 years, female sex, previous MI, and smoking. Median pain-to-call time was 2 hours, and median time from the onset of pain to arrival into the CCU was 4 hours. There were 59 (7.6%) patients admitted to the CCU within recommended 90 minutes. Diabetic comorbidity was not associated with early death or with longer time from pain to emergency calls. Conclusion Some of the risk factors associated with adverse outcomes in MI are modifiable. Prehospital delay of 4 hours observed in patients who suffered an MI is too long, and more effort should be devoted to investments in health care and education of the general public regarding chest pain symptoms. PMID:25709463

  10. Does retirement reduce the risk of myocardial infarction? : A prospective registry linkage study of 617 511 Danish workers

    DEFF Research Database (Denmark)

    Olesen, Kasper; Rugulies, Reiner

    2014-01-01

    BACKGROUND: Recent studies have suggested that retirement may have beneficial effects on health outcomes. In this study we examined whether the risk of myocardial infarction (MI) was reduced following retirement in a Danish population sample. METHODS: Participants were 617 511 Danish workers, born between 1932 and 1948, entering the study at the age of 60, without previous known incidents of ischaemic heart disease. Information on retirement and MI were obtained from Danish national registers. A Cox proportional hazard model was used to address the relation between retirement and onset of MI, while adjusting for age, sex, income, occupational position, education, cohabitation and immigrant status. The participants were followed for up to 7 years. RESULTS: Of the study population, 3% were diagnosed with MI during follow-up. Retirement was associated with a modestly higher risk of MI with a hazard ratio of 1.11 (95% confidence interval: 1.06, 1.16) when comparing retirees with active workers of the same age. CONCLUSIONS: This study does not support the hypothesis that retirement reduces risk of MI. On the contrary, we find that retirement is associated with a modestly increased risk of MI.

  11. Use of ABCD2 risk scoring system to determine the short-term stroke risk in patients presenting to emergency department with transient ischaemic attack

    International Nuclear Information System (INIS)

    Objective: To determine the 3-day stroke risk of patients presenting to emergency department with transient ischaemic attack, and to evaluate the predictive value of ABCD2 (Age, Blood pressure, Clinical features, Duration of symptoms and Diabetes) score for these patients. Methods: The prospective study was conducted on patients with diagnosis of transient ischaemic attack who were divided into low (0-3 points), medium (4-5 points) and high (6-7 points) risk groups according to their ABCD2 scores. The sensitivity of the scoring system on estimation of the risk of stroke in 3 days was evaluated through receiver operating characteristic curve. SPSS 15 was used for data analysis. Results: Of the 64 patients in the study, none of the low-risk group had stroke. Stroke was present in 4 of 33 (12.12%) medium-risk patients, while there were 4 in 18 (22.22%) in the high-risk group. Sensitivity and specificity of each ABCD2 score for 3rd day stroke risk was calculated. In the receiver operating curve generated by these calculations, the c statistics was determined as 0.76 (95% CI: 0.64, 0.86; p<0.01) and the most appropriate cut-off score to dichotomise the study group was determined as 4. Conclusions: In transient ischaemic attack patients with an ABCD2 score of four or higher had a markedly increased short-term stroke risk, while those with a lower score were quite safe. It is appropriate to hospitalise patients with a score of four or more and investigate for underlying causr more and investigate for underlying cause and initiate treatment. (author)

  12. The Impact of Supplemental Education Services Program on Middle School At-Risk Learners' Math and Reading Scores

    Science.gov (United States)

    Maxwell, June B.

    2010-01-01

    In the state of Georgia, local school systems are under pressure to increase at-risk middle school students' state scores in reading and math. At the data site, the local school system implemented a supplemental education service (SES) program for at-risk students in order to pass the Georgia Criterion Referenced Competency Test (CRCT) in reading…

  13. Genetically elevated non-fasting triglycerides and calculated remnant cholesterol as causal risk factors for myocardial infarction

    DEFF Research Database (Denmark)

    JØrgensen, Anders Berg; Frikke-Schmidt, Ruth

    2012-01-01

    AimsElevated non-fasting triglycerides mark elevated levels of remnant cholesterol. Using a Mendelian randomization approach, we tested whether genetically increased remnant cholesterol in hypertriglyceridaemia due to genetic variation in the apolipoprotein A5 gene (APOA5) associates with an increased risk of myocardial infarction (MI).Methods and resultsWe resequenced the core promoter and coding regions of APOA5 in individuals with the lowest 1% (n = 95) and highest 2% (n = 190) triglyceride levels in the Copenhagen City Heart Study (CCHS, n = 10 391). Genetic variants which differed in frequency between the two extreme triglyceride groups (c.-1131T > C, S19W, and c.*31C > T; P-value: 0.06 to

  14. Consideration of QRS complex in addition to ST-segment abnormalities in the estimated "risk region" during acute anterior myocardial infarction

    DEFF Research Database (Denmark)

    van Hellemond, Irene E G; Bouwmeester, Sjoerd

    2011-01-01

    The myocardial area at risk (MaR) has been estimated in patients with acute myocardial infarction (AMI) by using ST segment-based electrocardiographic (ECG) methods. As the process from ischemia to infarction progresses, the ST-segment deviation is typically replaced by QRS abnormalities causing a falsely low estimated total MaR if determined by using ST segment-based methods. The purpose of this study was to investigate if consideration of the abnormalities in the QRS complex, in addition to those in the ST segment, provides a more accurate estimated total MaR during anterior AMI than by considering the ST segment alone.

  15. Myocardial area at risk after ST-elevation myocardial infarction measured with the late gadolinium enhancement after scar remodeling and T2-weighted cardiac magnetic resonance imaging

    DEFF Research Database (Denmark)

    LØnborg, Jacob; EngstrØm, Thomas

    2012-01-01

    To evaluate the myocardial area at risk (AAR) measured by the endocardial surface area (ESA) method on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) when applied after scar remodeling (3 months after index infarction) compared to T2-weighted CMR imaging. One hundred and sixty nine patients with ST-elevation myocardial infarction, treated with primary percutaneous coronary intervention, underwent one CMR within 1 week after index treatment to determine the AAR with T2-weighted imaging and a second scan 3 months after to measure AAR with the ESA method. There was a moderate correlation between the two methods (r = 0.86; P 

  16. Impact of Co-morbidity on the Risk of First-Time Myocardial Infarction, Stroke, or Death After Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging

    DEFF Research Database (Denmark)

    Schelde, Astrid Blicher; Schmidt, Morten

    2014-01-01

    The impact of co-morbidity on the cardiovascular risk after single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) remains unclear. We examined the association between a normal versus abnormal SPECT MPI scan on 10-year risk of myocardial infarction, stroke, and all-cause death, overall and according to co-morbidity level. We identified all patients without previous myocardial infarction or cerebrovascular disease, who had an SPECT MPI performed at Aarhus University Hospital Skejby during 1999 to 2011. We categorized the SPECT MPI scan as normal (no defects) or abnormal (reversible and/or fixed defects). Using nationwide medical registries, we obtained information on co-morbidity level (using Charlson co-morbidity index) and outcomes. We used Cox regression to compute hazard ratios with 95% confidence intervals (CIs), adjusting for gender, age, and co-morbidity level. Among 7,040 patients, 4,962 (70%) had normal scans and 2,078 (30%) abnormal scans. Patients with a normal versus abnormal scan had a 10-year risk of 5.7% versus 10.9% for myocardial infarction, 6.0% versus 7.8% for stroke, and 16.5% versus 29.0% for all-cause death. After adjustment, an abnormal scan was associated with increased risk of myocardial infarction (adjusted hazard ratio 1.73, 95% CI 1.37 to 2.18) and all-cause death (1.42, 95% CI 1.23 to 1.65) but not stroke (1.12, 95% CI 0.86 to 1.45). Co-morbidity level did not affect substantially the association between the scan result and the outcomes. In conclusion, independently of co-morbidity level, an abnormal SPECT MPI scan was associated with an increased 10-year risk of myocardial infarction and all-cause death but not stroke.

  17. Ten-year absolute risk of osteoporotic fractures according to BMD T score at menopause: the Danish Osteoporosis Prevention Study

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Vestergaard, Peter

    2006-01-01

    In the non-HRT arms of the DOPS study, 10-year fracture risk was higher at each level of T score than predicted by the Kanis algorithm. Under-reporting of fractures in registers and inclusion of HRT users are probable explanations for inappropriately low fracture risk estimates for younger women. INTRODUCTION: International recommendations highlight the importance of absolute fracture risk in establishing intervention thresholds. The available estimates of long-term risk have been derived by combining relative risks from meta-analyses with U.S. normative BMD data and Swedish fracture incidence records. We validated the 2001 Kanis risk algorithm using incident fractures observed in untreated women in the first 10 years of the Danish Osteoporosis Prevention Study (DOPS). Comparisons were also made with the relative risks derived from a recent meta-analysis of 12 cohort studies. MATERIALS AND METHODS: We analyzed DXA of the spine and hip from 872 women who were enrolled in the non-hormone replacement therapy (HRT) arms of the study and had not received HRT, bisphosphonates, or raloxifene. We collected verified reports of fractures at each visit. We focused on fractures of the hip, spine, shoulder, and forearm to provide risks comparable with the Kanis algorithm. Accordingly, asymptomatic radiographic vertebral fractures were not included. RESULTS: Seventy-eight women (9%) sustained relevant fractures. The risk of fracture increased by 1.32 (95% CI, 1.02; 1.70) for each unit decrease in femoral neck T score and by 1.30 (95% CI, 1.06; 1.58) for each unit decrease in lumbar spine T score at baseline. Absolute fracture risk was higher than expected from the Kanis algorithm at all T score levels. The difference was greatest for participants in the higher range of T scores. At T = -1, the observed risk was 10.9% as opposed to an expected risk of 5.7%. Relative risk gradients were similar to those of the recent meta-analysis. CONCLUSIONS: In healthy women, examined in the first year or two after menopause, 10-year fracture risk was higher at each level of BMD T score than expected from the model by Kanis et al. Inclusion of HRT users in the cohorts used may have led to higher BMD values and lower absolute fracture risk in the Kanis model. These longitudinal data can be used directly in estimating absolute fracture risk in untreated north European women from BMD at menopause.

  18. Using “Big Data” to Capture Overall Health Status: Properties and Predictive Value of a Claims-Based Health Risk Score

    Science.gov (United States)

    Hamad, Rita; Modrek, Sepideh; Kubo, Jessica; Goldstein, Benjamin A.; Cullen, Mark R.

    2015-01-01

    Background Investigators across many fields often struggle with how best to capture an individual’s overall health status, with options including both subjective and objective measures. With the increasing availability of “big data,” researchers can now take advantage of novel metrics of health status. These predictive algorithms were initially developed to forecast and manage expenditures, yet they represent an underutilized tool that could contribute significantly to health research. In this paper, we describe the properties and possible applications of one such “health risk score,” the DxCG Intelligence tool. Methods We link claims and administrative datasets on a cohort of U.S. workers during the period 1996–2011 (N = 14,161). We examine the risk score’s association with incident diagnoses of five disease conditions, and we link employee data with the National Death Index to characterize its relationship with mortality. We review prior studies documenting the risk score’s association with other health and non-health outcomes, including healthcare utilization, early retirement, and occupational injury. Results and Conclusions We find that the risk score is associated with outcomes across a variety of health and non-health domains. These examples demonstrate the broad applicability of this tool in multiple fields of research and illustrate its utility as a measure of overall health status for epidemiologists and other health researchers. PMID:25951622

  19. Leukotriene B 4} production in healthy subjects carrying variants of the arachidonate 5-lipoxygenase-activating protein gene associated with risk of myocardial infarction

    OpenAIRE

    Maznyczka, Annette; Mangino, Massimo; Whittaker, Andrew; Braund, Peter; Palmer, Tom; Tobin, Martin; Goodall, Alison H.; Bradding, Peter; Samani, Nilesh J.

    2006-01-01

    Abstract Leukotrienes are implicated in the pathogenesis of coronary artery disease. Recently two haplotypes (Hap A and Hap B) in the gene encoding arachidonate 5-lipoxygenase activating protein (ALOX5AP), the main regulator of 5-lipoxygenase, have been associated with a doubling of the risk of myocardial infarction. Studies have also shown that treatment with a leukotriene inhibitor reduces biomarkers for coronary risk in patients carrying HapA, raising the possibility of developi...

  20. Trends in Myocardial Infarction Rates and Case Fatality by Anatomical Location In Four US Communities, 1987-2008 (From the Atherosclerosis Risk in Communities [ARIC] Study)

    Science.gov (United States)

    Newman, Jonathan D.; Shimbo, Daichi; Baggett, Chris; Liu, Xiaoxi; Crow, Richard; Abraham, JoEllyn M.; Loehr, Laura R.; Wruck, Lisa M.; Folsom, Aaron R.; Rosamond, Wayne D.

    2014-01-01

    Although the incidence of and mortality following ST-segment elevation myocardial infarction (STEMI) is decreasing, time-trends in anatomical location of STEMI and associated short-term prognosis have not been examined in a population-based community study. We determined 22-year trends in age- and race-adjusted, gender-specific incidence rates and 28-day case fatality of hospitalized STEMI by anatomic infarct location among a stratified random sample of 35-74 year old residents of four communities in the Atherosclerosis Risk in Communities (ARIC) study. STEMI infarct location was assessed by 12-lead electrocardiograms (ECG) from the hospital record, and was coded as anterior, inferior, lateral and multi-location STEMI using the Minnesota Code. Between 1987 and 2008, a total of 4,845 patients had an incident STEMI; 37.2% were inferior STEMI; 32.8% were anterior; 16.8% occurred in multiple infarct locations and 13.2% were lateral STEMI. For inferior, anterior and lateral STEMI in both men and women, significant declines were observed in the age-adjusted annual incidence rate and the associated 28-day case fatality. In contrast, for STEMI in multiple infarct locations, neither the annual incidence rate nor the 28-day case fatality changed over time. The age- and race-adjusted annual incidence rate and associated 28-day case fatality of STEMI in anterior, inferior and lateral infarct locations declined over 22 years of surveillance; however, no decline was observed for STEMI in multiple infarct locations. In conclusion, our findings suggest there is room for improvement in the care of patients with multi-location STEMI. PMID:24063834

  1. Trends in myocardial infarction rates and case fatality by anatomical location in four United States communities, 1987 to 2008 (from the Atherosclerosis Risk in Communities Study).

    Science.gov (United States)

    Newman, Jonathan D; Shimbo, Daichi; Baggett, Chris; Liu, Xiaoxi; Crow, Richard; Abraham, Joellyn M; Loehr, Laura R; Wruck, Lisa M; Folsom, Aaron R; Rosamond, Wayne D

    2013-12-01

    Although the incidence of and mortality after ST-segment elevation myocardial infarction (STEMI) is decreasing, time trends in anatomical location of STEMI and associated short-term prognosis have not been examined in a population-based community study. We determined 22-year trends in age- and race-adjusted gender-specific incidences and 28-day case fatality of hospitalized STEMI by anatomic infarct location among a stratified random sample of 35- to 74-year-old residents of 4 communities in the Atherosclerosis Risk in Communities study. STEMI infarct location was assessed by 12-lead electrocardiograms from the hospital record and was coded as anterior, inferior, lateral, and multilocation STEMIs using the Minnesota code. From 1987 to 2008, a total of 4,845 patients had an incident STEMI; 37.2% were inferior STEMI, 32.8% were anterior, 16.8% occurred in multiple infarct locations, and 13.2% were lateral STEMI. For inferior, anterior, and lateral STEMIs in both men and women, significant decreases were observed in the age-adjusted annual incidence and the associated 28-day case fatality. In contrast, for STEMI in multiple infarct locations, neither the annual incidence nor the 28-day case fatality changed over time. The age- and race-adjusted annual incidence and associated 28-day case fatality of STEMI in anterior, inferior, and lateral infarct locations decreased during 22 years of surveillance; however, no decrease was observed for STEMI in multiple infarct locations. In conclusion, our findings suggest that there is room for improvement in the care of patients with multilocation STEMI. PMID:24063834

  2. Could symptoms and risk factors diagnose COPD? Development of a Diagnosis Score for COPD

    Directory of Open Access Journals (Sweden)

    Salameh P

    2012-09-01

    Full Text Available Pascale Salameh,1 Georges Khayat,2 Mirna Waked31Faculties of Pharmacy and of Public Health, Lebanese University, Beirut, 2Faculty of Medicine, Hôtel Dieu de France Hospital, Beirut and Saint Joseph University, Beirut, 3Faculty of Medicine, Saint George Hospital, Beirut and Balamand University, Beirut, LebanonBackground: Diagnosing chronic obstructive pulmonary disease (COPD without spirometry is still a challenge. Our objective in this study was to develop a scale for diagnosis of COPD.Methods: Data were taken from a cross-sectional epidemiological study. After reducing chronic respiratory symptoms, a logistic regression was used to select risk factors for and symptoms of COPD. The rounded coefficients generated a Diagnosis Score for COPD (DS-COPD, which was dichotomized and differentiated between COPD and other individuals with respiratory symptoms.Results: We constructed a tool for COPD diagnosis with good properties, comprising 12 items. The area under the curve was 0.849; the positive predictive value was 76% if the DS-COPD was >20 and the negative predictive value was 97% if the DS-COPD was <10. A DS-COPD of 10–19 represented a zone mostly suggestive of no COPD (77%. The score was also inversely correlated with forced expiratory volume in 1 second/forced vital capacity.Conclusion: In this study, a tool for diagnosis of COPD was constructed with good properties for use in the epidemiological setting, mainly in cases of low or high scoring. It would be of particular interest in the primary care setting, where spirometry may not be available. Prospective studies and application in clinical settings would be necessary to validate this scale further.Keywords: diagnosis, scale, development, spirometry

  3. Ten-year absolute risk of osteoporotic fractures according to BMD T score at menopause : the Danish Osteoporosis Prevention Study

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Vestergaard, Peter

    2006-01-01

    In the non-HRT arms of the DOPS study, 10-year fracture risk was higher at each level of T score than predicted by the Kanis algorithm. Under-reporting of fractures in registers and inclusion of HRT users are probable explanations for inappropriately low fracture risk estimates for younger women. INTRODUCTION: International recommendations highlight the importance of absolute fracture risk in establishing intervention thresholds. The available estimates of long-term risk have been derived by combining relative risks from meta-analyses with U.S. normative BMD data and Swedish fracture incidence records. We validated the 2001 Kanis risk algorithm using incident fractures observed in untreated women in the first 10 years of the Danish Osteoporosis Prevention Study (DOPS). Comparisons were also made with the relative risks derived from a recent meta-analysis of 12 cohort studies. MATERIALS AND METHODS: We analyzed DXA of the spine and hip from 872 women who were enrolled in the non-hormone replacement therapy (HRT) arms of the study and had not received HRT, bisphosphonates, or raloxifene. We collected verified reports of fractures at each visit. We focused on fractures of the hip, spine, shoulder, and forearm to provide risks comparable with the Kanis algorithm. Accordingly, asymptomatic radiographic vertebral fractures were not included. RESULTS: Seventy-eight women (9%) sustained relevant fractures. The risk of fracture increased by 1.32 (95% CI, 1.02; 1.70) for each unit decrease in femoral neck T score and by 1.30 (95% CI, 1.06; 1.58) for each unit decrease in lumbar spine T score at baseline. Absolute fracture risk was higher than expected from the Kanis algorithm at all T score levels. The difference was greatest for participants in the higher range of T scores. At T = -1, the observed risk was 10.9% as opposed to an expected risk of 5.7%. Relative risk gradients were similar to those of the recent meta-analysis. CONCLUSIONS: In healthy women, examined in the first year or two after menopause, 10-year fracturerisk was higher at each level of BMD T score than expected from the model by Kanis et al. Inclusion of HRT users in the cohorts used may have led to higher BMD values and lower absolute fracture risk in the Kanis model. These longitudinal data can be used directly in estimating absolute fracture risk in untreated north European women from BMD at menopause.

  4. Cancer of the Prostate Risk Assessment (CAPRA) Preoperative Score Versus Postoperative Score (CAPRA-S): Ability to Predict Cancer Progression and Decision-Making Regarding Adjuvant Therapy after Radical Prostatectomy

    OpenAIRE

    Seo, Won Ik; Kang, Pil Moon; Kang, Dong Il; Yoon, Jang Ho; Kim, Wansuk; Chung, Jae Il

    2014-01-01

    The University of California, San Francisco, announced in 2011 Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score which included pathologic data, but there were no results for comparing preoperative predictors with the CAPRA-S score. We evaluated the validation of the CAPRA-S score in our institution and compare the result with the preoperative progression predictor, CAPRA score. Data of 130 patients were reviewed who underwent radical prostatectomy for localized prostate can...

  5. Value of a risk scoring tool to predict respiratory syncytial virus disease severity and need for hospitalization in term infants.

    Science.gov (United States)

    Mosalli, Rafat; Abdul Moez, Asmaa Mostafa; Janish, Mohammed; Paes, Bosco

    2015-08-01

    Several environmental and demographic risk factors have been validated and are used to determine the risk of acquiring severe respiratory syncytial virus (RSV) infection and subsequent hospitalization in late preterm infants born at 33-35 weeks gestational age. The applicability of the same composite model of risk factors in the term population has not been fully explored. The primary objective of this pilot study was to establish whether a risk scoring tool (RST), could predict the severity of RSV infection in term, RSV-positive infants who were hospitalized. A retrospective observational study was conducted in a pediatric unit, over 2 RSV seasons (2011-2013). A convenient sample of 72 children was selected out of a total of 111 RSV-positive cases after exclusions. The RST was applied and a score of respiratory disease severity was determined for each patient. Demographic characteristics were analyzed by standard descriptive methods, ?(2) analysis was utilized for categorical data and ANOVA for comparison between the clinical severity groups and the RST score. A P-value <0.05 was considered significant. Sixty per cent (n?=?43) of all infants scored in the low-risk category compared to 26% (n?=?19) in the moderate and 14% (n?=?10) in the high-risk groups. RST scores were also inconsistent with disease severity. Mean (SD) RST scores for those with mild, moderate, and severe illness were 47.8 [16.4], 41.1 [20.39] and, 41.7 [19.8], respectively (P?=?0.17). In conclusion, the RST did not predict accurately the clinical severity of RSV bronchiolitis in term infants nor did it correlate with risk for RSV-related hospitalization. J. Med. Virol. 87:1285-1291, 2015. © 2015 Wiley Periodicals, Inc. PMID:25784593

  6. Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: A multicenter study

    OpenAIRE

    Giles, MF; Albers, GW; Amarenco, P; Arsava, EM; Asimos, AW; Ay, H; Calvet, D.; Coutts, SB; Cucchiara, BL; Demchuk, AM; Johnston, SC; Kelly, PJ (Paul); Kim, AS; Labreuche, J; Lavallee, PC

    2011-01-01

    OBJECTIVES: Stroke risk immediately after TIA defined by time-based criteria is high, and prognostic scores (ABCD2 and ABCD3-I) have been developed to assist management. The American Stroke Association has proposed changing the criteria for the distinction between TIA and stroke from time-based to tissue-based. Research using these definitions is lacking. In a multicenter observational cohort study, we have investigated prognosis and performance of the ABCD2 score in TIA, subcategorized as ti...

  7. The value of radionuclide angiography for risk assessment of patients following acute myocardial infarction

    International Nuclear Information System (INIS)

    Radionuclide angiography (RNA) is an accurate noninvasive method for the evaluation of left ventricular function at rest and exercise. Both the change in ejection fraction from rest to exercise and the exercise ejection fraction correlate with the severity of coronary artery disease and are more sensitive than ST-segment changes for detecting abnormalities due to exercise-induced myocardial ischemia. The amount of left ventricular dysfunction produced acutely by myocardial ischemia appears to vary linearly with the severity of ischemia produced. Thus rest and exercise RNA provide information noninvasively regarding both the severity of left ventricular dysfunction and the amount of potentially ischemic myocardium, two of the three major pathophysiologic mechanisms related to prognosis. It is reasonable to hypothesize that rest and exercise RNA may provide useful prognostic information concerning subsequent mortality and morbidity in survivors of acute myocardial infarction

  8. Improved cognition after control of risk factors for multi-infarct dementia

    International Nuclear Information System (INIS)

    A cohort of 52 patients (30 men and 22 women) with multi-infarct dementia (MID) has been followed up prospectively for a mean interval of 22.2 months. Clinical course has been documented by serial history taking and interviews and neurological, medical, and psychological examinations, and correlated with measurements of cerebral blood flow. The clinical course and cognitive performance have been compared with those of age-matched normal volunteers and patients with Alzheimer's disease. Patients with MID were subdivided into hypertensive and normotensive groups, and also into those displaying stabilized or improved cognition and those whose condition deteriorated. Among hypertensive patients with MID, improved cognition and clinical course correlated with control of systolic blood pressure within upper limits of normalf (135 to 150 mm Hg), but if systolic blood pressure was reduced below this level, patients with MID deteriorated. Among normotensive patients with MID, improved cognition was associated with cessation of smoking cigarettes

  9. The Risk Assessment Score in acute whiplash injury predicts outcome and reflects bio-psycho-social factors

    DEFF Research Database (Denmark)

    Kasch, Helge; Qerama, Erisela

    2011-01-01

    ABSTRACT: Study Design. 1-year prospective study of 141 acute whiplash patients (WLP) and 40 acute ankle injured controlsObjective. This study investigates a priori determined potential risk factors in order to develop a risk assessment tool, for which the expediency was examinedSummary of Background Data. The Whiplash Associated Disorders (WAD) grading system that emerged from The Quebec Task-force-on-Whiplash has been of limited value for predicting work-related recovery and for explaining bio-psychosocial disability after whiplash and new predictive factors e.g. risk criteria that comprehensively differentiate acute WLP in a bio-psycho-social manner are needed.Methods. Consecutively 141 acute WLP and 40 ankle injured recruited from emergency units were examined after 1 week, 1, 3, 6, 12 months obtaining neck/head VAS score, number-of-non-painful complaints, epidemiological, social, psychological data and neurological examination, active neck mobility, and furthermore muscle tenderness and pain response, strength and duration of neck muscles. Risk factors derived (reduced CROM, intense neckpain/headache, multiple non-pain complaints) were applied in a Risk Assessment Score and divided into 7 risk-strata.Results. A ROC curve for the Risk Assessment Score and 1-year work disability showed an area of 0.90. Risk strata and number of sick days showed a log-linear relationship. In stratum 1 full recovery was encountered, but for high risk patients in stratum 6 only 50% and 7 only 20% had returned to work after 1-yr (p <5.4 * 10). Strength measures, psychophysical pain measurements and psychological and social data (reported elsewhere) showed significant relation to risk strata.Conclusion. The Risk Assessment score is suggested as a valuable tool for grading WLP early after injury. It has reasonable screening power for encountering work disability and reflects the bio-psycho-social nature of whiplash injuries.

  10. Postpartum thromboembolism: Severe events might be preventable using a new risk score model

    Directory of Open Access Journals (Sweden)

    Pelle G Lindqvist

    2008-08-01

    Full Text Available Pelle G Lindqvist1,3, Jelena Torsson2, Åsa Almqvist1, Ola Björgell21Department of Obstetrics and Gynecology; 2Radiology, Malmö University Hospital, Lund University, Malmö, Sweden; 3Department of Obstetrics and Gynecology, Karolinska Hospital, Huddinge, SwedenBackground: Pregnancy-related venous thromboembolism (VTE is a major cause of maternal morbidity and mortality. A new risk assessment model for VTE in relation to pregnancy has been introduced in Sweden. We wished to determine the proportion of preventable VTE cases if the model had been in use and make a brief cost-benefit analysis.Methods: A hospital-based retrospective case-control study of all postpartum thromboembolic instances of deep venous thrombosis and pulmonary embolisms during a 16-year period. Large anamnestic risk factors at the time of delivery were assessed. We correlated the findings with the new Swedish guidelines for thromboprophylaxis.Results: We found 37 cases of postpartum VTE during the study period. Nineteen of all VTE cases (51% and eight out of eleven of cases of pulmonary embolism (73% had two or more large anamnestic risk factors, ie, they would have been subjected to thromboprophylaxis if the new guidelines had been used. The cost of each preventable VTE was lower than treating a VTE.Conclusion: Approximately one-half of postpartum VTE cases and 70% of pulmonary emboli cases have at least two large risk factors and might be preventable using the new algorithm. From the perspective of the health care system the new recommendations appears to be cost-effective.Keywords: thromboprophylaxis, low molecular weight heparin, scoring system, health care financing, ultrasonography, phlebography

  11. Puntaje de riesgo para morbilidad y mortalidad en pacientes sometidos a intervencionismo coronario percutáneo / Morbimortality risk score in patients submitted to percutaneous coronary intervention

    Scientific Electronic Library Online (English)

    Andrés, Fernández; Carlos A, Tenorio; Carlos A, Eusse; Arturo, Rodríguez; Carlos E, Uribe; Juan P, Villa; Ricardo, Restrepo; Marcela, Mejia; Juliana, Vega; Juan F, Gómez; Gloria, Franco.

    2008-04-01

    Full Text Available El objetivo principal de este estudio observacional, fue establecer un puntaje de riesgo para morbilidad y mortalidad intrahospitalaria en pacientes sometidos a intervención coronaria percutánea luego de sufrir alguno de los siguientes síndromes coronarios agudos: angina inestable, infarto agudo del [...] miocardio sin elevación del segmento ST o infarto agudo del miocardio con elevación del segmento ST. Se realizó una recolección de datos clínicos y demográficos a partir de 1.310 pacientes atendidos en la clínica, entre 2003 a 2006, de manera retro-prospectiva, con el fin de elaborar un puntaje válido para la población colombiana. Esto se realizó mediante una base de datos de múltiples variables pre-procedimiento (antecedentes personales), variables intra-procedimiento (tiempo transcurrido desde la hora de la consulta al servicio de urgencias hasta el momento del cateterismo, número de vasos enfermos entre otros) y variables post-procedimientos (complicaciones de morbi-mortalidad). Luego, el análisis de los datos se llevó a cabo mediante un modelo de regresión logística, para determinar cuáles de los factores de riesgo fueron estadísticamente significativos para causar alguno de los resultados evaluados. Los principales resultados evaluados fueron: muerte, eventos hematológicos adversos y estancia hospitalaria. Luego del análisis se encontró que los principales factores relacionados con la morbi-mortalidad de los pacientes fueron el tipo de paciente (o tipo de síndrome coronario sufrido), su edad y su estado hemodinámico al ingreso (presencia de shock cardiogénico). A partir de estos resultados, se desarrolló el puntaje de riesgo a través de las variables pre-operatorias e intra-operatorias. Abstract in english The main objective of this observational study was to establish a mortality risk score for intra-hospital morbidity and mortality in patients submitted to percutaneous coronary intervention (PCI) after having suffered one of the following acute coronary syndromes: unstable angina (UA), acute myocard [...] ial infarction without ST elevation (NSTEMI) or acute myocardial infarct with ST elevation (STEMI). Clinical and demographic data of 1,300 patients treated in the clinic between 2003 and 2006 were recollected in a retrospective way with the aim of obtaining a valid risk score for the Colombian population. This was realized through a data base of multiple pre-procedure variables (personal antecedents), intra-procedure variables (time elapsed since the arrival to ER to the moment of catheterization and number of diseased vessels among others) and post-procedure variables (morbimortality complications). Data analysis was then performed through a logistic regression model in order to determine which risk factors were statistically significant in causing some of the results evaluated. The principal results evaluated were death, adverse hematological events and hospital stay; after the analysis we found that the main factors related to patients’ morbimortality, were the type of patient (or the type of coronary syndrome suffered), age and homodynamic state at admission (presence of cardiogenic shock). From these results a risk score through pre-procedure, post-procedure and intra-hospital variables was developed.

  12. Application of the pediatric risk of mortality (PRISM score and determination of mortality risk factors in a tertiary pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Graziela Araujo Costa

    2010-01-01

    Full Text Available INTRODUCTION: To establish disease severity at admission can be performed by way of the mortality prognostic. Nowadays the prognostic scores make part of quality control and research. The Pediatric Risk of Mortality is one of the scores used in the pediatric intensive care units. OBJECTIVES: The purpose of this study is the utilization of the pediatric risk of mortality to determine mortality risk factors in a tertiary pediatric intensive care units. METHODS: Retrospective cohort study, in a period of one year, at a general tertiary pediatric intensive care unit. The pediatric risk of mortality scores corresponding to the first 24 hours of hospitalization were recorded; additional data were collected to characterize the study population. RESULTS: 359 patients were included; the variables that were found to be risk factors for death were multiple organ dysfunction syndrome, mechanical ventilation, use of vasoactive drugs, hospital-acquired infection, parenteral nutrition and duration of hospitalization (p < 0,0001. Fifty-four patients (15% died; median pediatric risk of mortality score was significantly lower in patients who survived (p=0,0001. The ROC curve yielded a value of 0.76 (CI 95% 0,69-0,83 and the calibration was shown to be adequate. DISCUSSION: It is imperative for pediatric intensive care units to implement strict quality controls to identify groups at risk of death and to ensure the adequacy of treatment. Although some authors have shown that the PRISM score overestimates mortality and that it is not appropriate in specific pediatric populations, in this study pediatric risk of mortality showed satisfactory discriminatory performance in differentiating between survivors and non-survivors. CONCLUSIONS: The pediatric risk of mortality score showed adequate discriminatory capacity and thus constitutes a useful tool for the assessment of prognosis for pediatric patients admitted to a tertiary pediatric intensive care units.

  13. The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0-1 : a nationwide cohort study

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Torp-Pedersen, Christian

    2012-01-01

    North American and European guidelines on atrial fibrillation (AF) are conflicting regarding the classification of patients at low/intermediate risk of stroke. We aimed to investigate if the CHA2DS2-VASc score improved risk stratification of AF patients with a CHADS2 score of 0-1. Using individual-level-linkage of nationwide Danish registries 1997-2008, we identified patients discharged with AF having a CHADS2 score of 0-1 and not treated with vitamin K antagonist or heparin. In patients with a CHADS2 score of 0, 1, and 0-1, rates of stroke/ thromboembolism were determined according to CHA2DS2-VASc score, and the risk associated with increasing CHA2DS2-VASc score was estimated in Cox regression models adjusted for year of inclusion and antiplatelet therapy. The value of adding the extra CHA2DS2-VASc risk factors to the CHADS2 score was evaluated by c-statistics, Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI). We included 47,576 patients with a CHADS2 score of 0-1, from these 7,536 (15.8%) were CHA2DS2-VASc score=0, 10,062 (21.2%) were CHA2DS2-VASc score=1, 14,310 (30.1%) were CHA2DS2-VASc score=2, 14,188 (29.8%) were CHA2DS2-VASc score=3, and 1,480 (3.1%) were CHA2DS2-VASc score=4. Of the cohort with a CHADS2 score of 0-1, the stroke/thromboembolism rate per 100 person-years increased with increasing CHA2DS2-VASc score (95% confidence interval): 0.84 (0.65-1.08), 1.79 (1.53-2.09), 3.67 (3.34-4.03), 5.75 (5.33-6.21), and 8.18 (6.68-10.02) at one year follow-up with CHA2DS2-VASc scores of 0, 1, 2, 3, and 4, respectively. Patients with a CHADS2 score=0 were not all 'low risk', with one-year event rates ranging from 0.84 (CHA2DS2-VASc score=0) to 3.2 (CHA2DS2-VASc score=3). Results from Cox regression analyses, NRI, and IDI confirmed the improved predictive ability of the CHA2DS2-VASc score in the AF patients who have a CHADS2 score of 0-1. In conclusion, the CHA2DS2-VASc provides critical information on risk of stroke in AF patients with a CHADS2 score of 0-1 that can aid a decision of using anticoagulation. Even in patients categorised as 'low risk' using a CHADS2 score=0, the CHA2DS2-VASc score significantly improved the predictive value of the CHADS2 score alone and a CHA2DS2-VASc score=0 could clearly identify 'truly low risk' subjects. Use of the CHA2DS2-VASc score would significantly improve classification of AF patients at low and intermediate risk of stroke, compared to the commonly used CHADS2 score.

  14. Polygenic Risk Score, Parental Socioeconomic Status, Family History of Psychiatric Disorders, and the Risk for Schizophrenia : A Danish Population-Based Study and Meta-analysis

    DEFF Research Database (Denmark)

    Agerbo, Esben; Sullivan, Patrick F

    2015-01-01

    Importance: Schizophrenia has a complex etiology influenced both by genetic and nongenetic factors but disentangling these factors is difficult. Objective: To estimate (1) how strongly the risk for schizophrenia relates to the mutual effect of the polygenic risk score, parental socioeconomic status, and family history of psychiatric disorders; (2) the fraction of cases that could be prevented if no one was exposed to these factors; (3) whether family background interacts with an individual's genetic liability so that specific subgroups are particularly risk prone; and (4) to what extent a proband's genetic makeup mediates the risk associated with familial background. Design, Settings, and Participants: We conducted a nested case-control study based on Danish population-based registers. The study consisted of 866 patients diagnosed as having schizophrenia between January 1, 1994, and December 31, 2006, and 871 matched control individuals. Genome-wide data and family psychiatric and socioeconomic background information were obtained from neonatal biobanks and national registers. Results from a separate meta-analysis (34?600 cases and 45?968 control individuals) were applied to calculate polygenic risk scores. Exposures: Polygenic risk scores, parental socioeconomic status, and family psychiatric history. Main Outcomes and Measures: Odds ratios (ORs), attributable risks, liability R2 values, and proportions mediated. Results: Schizophrenia was associated with the polygenic risk score (OR, 8.01; 95% CI, 4.53-14.16 for highest vs lowest decile), socioeconomic status (OR, 8.10; 95% CI, 3.24-20.3 for 6 vs no exposures), and a history of schizophrenia/psychoses (OR, 4.18; 95% CI, 2.57-6.79). The R2 values were 3.4% (95% CI, 2.1-4.6) for the polygenic risk score, 3.1% (95% CI, 1.9-4.3) for parental socioeconomic status, and 3.4% (95% CI, 2.1-4.6) for family history. Socioeconomic status and psychiatric history accounted for 45.8% (95% CI, 36.1-55.5) and 25.8% (95% CI, 21.2-30.5) of cases, respectively. There was an interaction between the polygenic risk score and family history (P?=?.03). A total of 17.4% (95% CI, 9.1-26.6) of the effect associated with family history of schizophrenia/psychoses was mediated through the polygenic risk score. Conclusions and Relevance: Schizophrenia was associated with the polygenic risk score, family psychiatric history, and socioeconomic status. Our study demonstrated that family history of schizophrenia/psychoses is partly mediated through the individual's genetic liability.

  15. Prevalence of risk factors of ST segment elevation myocardial infarction in Turkish patients living in Central Anatolia

    Directory of Open Access Journals (Sweden)

    Hüseyin U?ur Yaz?c?

    2009-02-01

    Full Text Available Objective: There is not enough available data in our country about the prevalence of risk factors for ST-elevation myocardial infarction (STEMI, which has the highest in-hospital mortality rate within subtypes of acute coronary syndromes. Therefore, in this study, we aimed to evaluate the prevalence of risk factors for STEMI in Central Anatolia, one of the regions with high risk for coronary heart disease (CHD. Methods: This cross-sectional observational study included 1210 patients (962 men, 248 women with the diagnosis of STEMI in 3 tertiary-medical centers in 3 cities in Central-Anatolia (Ankara, Konya, and Kayseri. Demographic characteristics (age, gender and risk factors known to be traditional risk factors for CHD (history of hypertension (HT, diabetes mellitus (DM, smoking, and family history were inquired and fasting blood samples within 24 hours from onset of STEMI were taken to analyze lipid levels. Patients were divided into 3 groups based on their ages: Group A - age ?44 years; Group B - age 45-64 years; and Group C - age?65 years. Prevalence of risk factors and differences within age-groups and genders were evaluated.Results: The mean age was 58±11 years (range 24-96 years. Although the percentage of female patients increased in relation to increasing age, 80% of the total patients were male. While prevalence of smoking and family history was observed to decrease with aging, there was a statistically significant increase in prevalence of HT and DM (p<0.001. Prevalence of smoking was the highest in young patients and males (p<0.001. Prevalence of HT and DM, on the other hand, was significantly higher in women than in men (p<0.001. Although the number of modifiable risk factors was found to be significantly smaller in men, male patients with STEMI were 8 years younger than females on average.Conclusions: The results of our study, in which modifiable risk factors and especially smoking were found to have a high prevalence in patients with STEMI living in Central Anatolia, suggested that most STEMI cases especially at younger ages might be prevented by the modification of these risk factors.

  16. Acute myocardial infarction

    International Nuclear Information System (INIS)

    To evaluate the extent and characteristics of infarct areas, we performed indium-111 monoclonal antimyosin Fab (InAM), thallium-201 (TL) and Tc-99m pyrophosphate (PYP) imagings in 17 patients with acute myocardial infarction, and tried to find out the mechanism that causes difference of these imagings. In each study, the extent scores as an index of the infarct area were obtained by single photon emission computed tomography (SPECT), and comparisons were made between the results obtained. The overlap between InAM and TL imagings obtained by SPECT was evaluated. Location, severity, extent and patterns of accumulation were compared between InAM and PYP with both planar image and SPECT. The extent scores of InAM correlated well with those of TL (r=0.73, p<0.01). However, the overlap of both methods was recognized in 8 of 17 patients, in whom wall thickness of the infarct area as obtained by echocardiography was well preserved. The left ventricular regional asynergy was mild in 6 of these 8 patients. Coronary angiography showed poor or no collateral circulation in these cases. Although there were generally close correlations of the extent scores between InAM and PYP, discrepancy was noted in 2 cases for location; 2 for severity, 5 for extent, and 3 for patterns of accumulation. These differences may be attributed to the timings of imaging, coronary reperfusion and different mechanisms of accumulation. In conclusion, the extent of acute myocardial infarction obtained by Inacute myocardial infarction obtained by InAM correlates well with those obtained by TL and PYP, with some exceptions. (author)

  17. Implantable cardioverter-defibrillator registry risk score models for acute procedural complications or death after implantable cardioverter-defibrillator implantation.

    LENUS (Irish Health Repository)

    Haines, David E

    2012-02-01

    BACKGROUND: Patients undergoing implantable cardioverter-defibrillator (ICD) implantation are at risk of postprocedural complications. However, we do not have a risk stratification schema to identify patients at high and low risk of adverse events. METHODS AND RESULTS: We analyzed data from 268 701 ICD implants submitted to the ICD Registry and developed logistic regression models to identify variables most strongly associated with the risk of acute complications and\\/or in-hospital death. Overall, 3.2% of the population experienced an adverse event. A simple risk score consisting of 10 readily available variables successfully identified patients at high and low risk of complications. The variables included in the score and assigned points included: age >\\/= 70 years (1 point), female (2 points), New York Heart Association class III (1 point) or IV (3 points), atrial fibrillation (1 point), prior valve surgery (3 points), chronic lung disease (2 points), blood urea nitrogen >30 (2 points), reimplantation for reasons other than battery change (6 points), ICD type dual chamber (2 points) or biventricular (4 points), and nonelective ICD implant (3 points). The risk of any in-hospital complication increased from 0.6% among patients with a score of <\\/= 5 (8.4% of the population) to 8.4% among patients with >\\/= 19 risk points (3.9% of the population). CONCLUSIONS: A simple risk score consisting of readily available clinical variables can identify high- and low-risk subsets of patients undergoing ICD implantation. This information can guide the physician in patient selection and determining the intensity of care required post procedure.

  18. Risk stratification of cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts by 24-hour ambulatory blood pressure monitoring

    International Nuclear Information System (INIS)

    Our goal was to investigate the utility of 24-hour ambulatory blood pressure monitoring (ABPM) for the risk stratification of cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts. A total of 175 hypertensive patients with MRI evidence of asymptomatic or symptomatic lacunar infarcts (92 men, mean age of 69±11 years old) were studied. Patients with symptomatic infarctions were included whose events occurred more than 6 months after the onset. ABPM was performed in all patients in the outpatient clinic. Parameters obtained from ABPM were related to the composite outcome which consisted of all death and fatal or non-fatal cardiovascular events by using the Cox proportional hazard model. Mean follow-up period was 4.8 years and the composite outcome was recorded in 38 patients. 34 of them (89%) had recurrence of lacunar infarcts. Significant association between sleep-time lowest systolic blood pressure and composite outcome was demonstrated by multivariate Cox hazard analyses (heart rate (HR) 1.025, 95% confidence interval (CI) 1.011-1.039, p<0.001). The risk for composite outcome in patients with the highest tertile of sleep-time lowest systolic blood pressure (?133 mmHg) was significantly elevated when compared to the lowest tertile (<132 mmHg, HR 3.93, 95% CI 1.57-9.86, p=0.004). Sleep-time lowest systolic blood pressure in ABPM may be a useful parameter for the risk stratification of future cardiovascular events in hypertenuture cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts, especially for the recurrence of these events. (author)

  19. Beyond the established risk factors of myocardial infarction : lifestyle factors and novel biomarkers

    OpenAIRE

    Wennberg, Patrik

    2009-01-01

    Age, male sex, hypertension, smoking, diabetes, dyslipidaemia, and obesity are considered as established risk factors for cardiovascular diseases. Several of these established cardiovascular risk factors are strongly influenced by lifestyle. Novel biomarkers from different mechanistic pathways have been associated with cardiovascular risk, but their clinical utility is still uncertain. The overall objective of the thesis was to evaluate the associations between certain lifestyle factors (phys...

  20. CHADS2 and CHA2DS2-VASc score to assess risk of stroke and death in patients paced for sick sinus syndrome

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Nielsen, Jens Cosedis

    2013-01-01

    The risk of stroke in patients with atrial fibrillation (AF) can be assessed by use of the CHADS2 and the CHA2DS2-VASc score system. We hypothesised that these risk scores and their individual components could also be applied to patients paced for sick sinus syndrome (SSS) to evaluate risk of stroke and death.

  1. Interactions of Lipid Genetic Risk Scores with Estimates of Metabolic Health in a Danish Population

    DEFF Research Database (Denmark)

    Justesen, Johanne M; Allin, Kristine H

    2015-01-01

    BACKGROUND: -There are several well-established lifestyle factors influencing dyslipidemia and currently, 157 genetic susceptibility loci have been reported to be associated with serum lipid levels at genome-wide statistical significance. However, the interplay between lifestyle risk factors and these susceptibility loci has not been fully elucidated. We tested if genetic risk scores (GRS) of lipid-associated SNPs associate with fasting serum lipid traits and if the effects are modulated by lifestyle factors or estimates of metabolic health. METHODS AND RESULTS: -The SNPs were genotyped in two Danish cohorts: Inter99 (n=5,961) for discovery analyses and Health2006 (n=2,565) for replication. Based on published effect sizes of SNPs associated with circulating fasting levels of total cholesterol, LDL-cholesterol, HDL-cholesterol or triglyceride, four weighted GRS (wGRS) were constructed. In a cross-sectional design, we investigated if the effect of these wGRSs on lipid levels were modulated by diet, alcohol consumption, physical activity and smoking or the individual metabolic health status as estimated from BMI, waist circumference and insulin resistance assessed using HOMA-IR. All four lipid wGRSs associated strongly with their respective trait (from P=3.3×10(-69) to P=1.1×10(-123)). We found interactions between the triglyceride wGRS and BMI and waist circumference on fasting triglyceride levels in Inter99 and replicated these findings in Health2006 (Pinteraction=9.8×10(-5) and 2.0×10(-5), respectively in combined analysis). CONCLUSIONS: -Our findings suggest that individuals who are obese may be more susceptible to the cumulative genetic burden of triglyceride SNPs. Therefore, it is suggested that especially these genetically at-risk individuals may benefit more from targeted interventions aiming at obesity prevention.

  2. Framingham risk score modifies the effect of PM10 on heart rate variability.

    Science.gov (United States)

    Feng, Yingying; Huang, Xiji; Sun, Huizhen; Liu, Chuanyao; Zhang, Bing; Zhang, Zhihong; Sharma Tengur, Vashish; Chen, Weihong; Wu, Tangchun; Yuan, Jing; Zhang, Xiaomin

    2015-08-01

    Health conditions may greatly modify the association between particulate matter (PM) and heart rate variability (HRV), but whether the modification of PM effect by coronary artery disease (CAD) risk status depends on the PM levels remains unknown. We investigated the associations between personal exposures to PM with aerodynamic diameter of ?10?m (PM10) and ?2.5?m (PM2.5) and concurrent HRV, and whether the effect of PM on HRV was modified by Framingham risk score (FRS) in healthy subjects with different PM exposure levels. Personal exposures to PM10 and PM2.5 were measured for 24h in 152 volunteers of community residents who were free of cardiovascular disease in two cities (Zhuhai and Wuhan) that differ in air quality. Simultaneously, 24h HRV indices were obtained from 3-channel Holter monitor. FRS was calculated based on age, sex, lipid profiles, blood pressure, diabetes, and smoking status. Linear regression models were constructed after adjusting for potential confounders. We found significant decrease in total power (TP) and low power (LF) with increased PM10 concentrations (P for trend<0.05) in the high PM levels city (Wuhan) and total population, but not in the low PM levels city (Zhuhai). We also observed significant modification of FRS on PM10 effect in Wuhan. Interestingly, elevated PM10 was associated in a greater decreased HRV in the low FRS subgroup, but not in the high FRS subgroup. However, we did not find any significant main effects of PM2.5 or PM2.5-FRS interactions on HRV in city-specified or city-combined analyses. Overall, the findings indicate that individual coronary risk profiles may modulate the association between particulate air pollution and HRV in high PM exposure levels. PMID:25863505

  3. Adipose tissue arachidonic acid content is associated with the risk of myocardial infarction : A Danish case-cohort study

    DEFF Research Database (Denmark)

    Nielsen, Michael René Skjelbo; Schmidt, Erik Berg

    2013-01-01

    OBJECTIVE: The primary aim of the study was to evaluate the association between adipose tissue arachidonic acid (AA) content and the risk of myocardial infarction (MI). The secondary aim was to assess the correlation between adipose tissue AA and dietary intake of AA and linoleic acid (LA). METHODS: We conducted a case-cohort study nested within the Danish prospective Diet, Cancer and Health (DCH) study. After appropriate exclusions, the study included 2134 incident MI cases. Gluteal adipose tissue biopsies were collected at recruitment, and the fatty acid composition was determined by gas chromatography. A weighted Cox proportional hazards model was used to evaluate the association between adipose tissue AA content and the risk of MI. RESULTS: After adjusting for confounders we found a positive association between adipose tissue AA content and the risk of MI. Hazard ratios (HR) of MI relative to the lowest quintile of adipose tissue AA content, increased across quintiles; second quintile (HR 1.19 95%CI: 0.97-1.45), third (HR 1.24 95%CI: 1.02-1.52), fourth (HR 1.28 95%CI: 1.03-1.60), and fifth quintile (HR 1.39 95%CI: 1.10-1.77). Adipose tissue AA levels were not correlated with dietary intake of AA (r=0.03, 95%CI: -0.01, 0.06) and weakly negatively correlated with dietary intake of LA (r=-0.12, 95%CI: -0.15, -0.08). CONCLUSIONS: The adipose tissue content of AA was positively associated with the risk of MI but did not correlate with dietary intake of neither AA nor LA.

  4. Meta-analysis of randomized controlled trials on risk of myocardial infarction from the use of oral direct thrombin inhibitors.

    Science.gov (United States)

    Artang, Ramin; Rome, Eric; Nielsen, Jørn Dalsgaard; Vidaillet, Humberto J

    2013-12-15

    Dabigatran has been associated with greater risk of myocardial infarction (MI) than warfarin. It is unknown whether the increased risk is unique to dabigatran, an adverse effect shared by other oral direct thrombin inhibitors (DTIs), or the result of a protective effect of warfarin against MI. To address these questions, we systematically searched MEDLINE and performed a meta-analysis on randomized trials that compared oral DTIs with warfarin for any indication with end point of MIs after randomization. We furthermore performed a secondary meta-analysis on atrial fibrillation stroke prevention trials with alternative anticoagulants compared with warfarin with end point of MIs after randomization. A total of 11 trials (39,357 patients) that compared warfarin to DTIs (dabigatran, ximelagatran, and AZD0837) were identified. In these trials, patients treated with oral DTIs were more likely to experience an MI than their counterparts treated with warfarin (285 of 23,333 vs 133 of 16,024, odds ratio 1.35, 95% confidence interval 1.10 to 1.66, p = 0.005). For secondary analysis, 8 studies (69,615 patients) were identified that compared warfarin with alternative anticoagulant including factor Xa inhibitors, DTIs, aspirin, and clopidogrel. There was no significant advantage in the rate of MIs with the use of warfarin versus comparators (odds ratio 1.06, 95% confidence interval 0.85 to 1.34, p = 0.59). In conclusion, our data suggest that oral DTIs were associated with increased risk of MI. This increased risk appears to be a class effect of these agents, not a specific phenomenon unique to dabigatran or protective effect of warfarin. These findings support the need for enhanced postmarket surveillance of oral DTIs and other novel agents. PMID:24075284

  5. Pain-to-hospital times, cardiovascular risk factors, and early intrahospital mortality in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Brkovi? E

    2015-02-01

    Full Text Available Eliana Brkovi?,1 Katarina Novak,2,3 Livia Puljak3 1Department of Psychiatry, 2Department of Internal Medicine, Division of Cardiology, 3Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia Background: The aim of the study was to analyze the most recent trends in myocardial infarction (MI care, the number of patients treated for MI and their outcomes, cardiovascular disease risk factors, and pain-to-hospital times in MI patients. Subjects and methods: For 778 patients treated for acute MI at the Coronary Care Unit (CCU of University Hospital Split, Croatia the following data were acquired: outcome during hospitalization (survived, deceased, cardiovascular risk factors (hypertension, diabetes, dyslipidemia, previous MI, smoking, and pain-to-CCU time. Results: Among 778 patients treated for acute MI, there were 291 (37% women and 487 (63% men. Forty-five patients (6% died during hospitalization, mostly due to cardiogenic shock. An association was found between early intrahospital mortality and the following risk factors: age >70 years, female sex, previous MI, and smoking. Median pain-to-call time was 2 hours, and median time from the onset of pain to arrival into the CCU was 4 hours. There were 59 (7.6% patients admitted to the CCU within recommended 90 minutes. Diabetic comorbidity was not associated with early death or with longer time from pain to emergency calls. Conclusion: Some of the risk factors associated with adverse outcomes in MI are modifiable. Prehospital delay of 4 hours observed in patients who suffered an MI is too long, and more effort should be devoted to investments in health care and education of the general public regarding chest pain symptoms. Keywords: prehospital delay, ischemic heart disease

  6. Meta-analysis of randomized controlled trials on risk of myocardial infarction from the use of oral direct thrombin inhibitors

    DEFF Research Database (Denmark)

    Artang, Ramin; Rome, Eric

    2013-01-01

    Dabigatran has been associated with greater risk of myocardial infarction (MI) than warfarin. It is unknown whether the increased risk is unique to dabigatran, an adverse effect shared by other oral direct thrombin inhibitors (DTIs), or the result of a protective effect of warfarin against MI. To address these questions, we systematically searched MEDLINE and performed a meta-analysis on randomized trials that compared oral DTIs with warfarin for any indication with end point of MIs after randomization. We furthermore performed a secondary meta-analysis on atrial fibrillation stroke prevention trials with alternative anticoagulants compared with warfarin with end point of MIs after randomization. A total of 11 trials (39,357 patients) that compared warfarin to DTIs (dabigatran, ximelagatran, and AZD0837) were identified. In these trials, patients treated with oral DTIs were more likely to experience an MI than their counterparts treated with warfarin (285 of 23,333 vs 133 of 16,024, odds ratio 1.35, 95% confidence interval 1.10 to 1.66, p = 0.005). For secondary analysis, 8 studies (69,615 patients) were identified that compared warfarin with alternative anticoagulant including factor Xa inhibitors, DTIs, aspirin, and clopidogrel. There was no significant advantage in the rate of MIs with the use of warfarin versus comparators (odds ratio 1.06, 95% confidence interval 0.85 to 1.34, p = 0.59). In conclusion, our data suggest that oral DTIs were associated with increased risk of MI. This increased risk appears to be a class effect of these agents, not a specific phenomenon unique to dabigatran or protective effect of warfarin. These findings support the need for enhanced postmarket surveillance of oral DTIs and other novel agents.

  7. Mejoría en el score de riesgo cardiovascular por la cirugía bariátrica / Improvement in the cardiovascular risk score due to bariatric surgery

    Scientific Electronic Library Online (English)

    Luz Sujey, Romero Loera; María Fernanda, Torres Ruiz; Carlos, Bravo Torreblanca; Itzé, Aguirre Olmedo; José Manuel, Morales Vargas; Luis Eduardo, Cárdenas Lailson.

    2012-09-01

    Full Text Available Introducción: La obesidad se ha considerado como un factor de riesgo para desarrollar eventos coronarios agudos. Los principales factores para desarrollar este tipo de enfermedades están presentes en la mayoría de los pacientes sometidos a cirugía bariátrica. Objetivo: Evaluar el riesgo cardiovascul [...] ar de los pacientes sometidos a cirugía bariátrica en forma preoperatoria y postoperatoria tras un seguimiento a dos años. Sede: Hospital General ''Dr. Manuel Gea González''. Diseño: Estudio retrospectivo, longitudinal, observacional y comparativo. Material y métodos: Pacientes de la clínica de cirugía bariátrica, operados con la técnica de bypass gástrico, calculando el riesgo cardiovascular de forma preoperatoria y posteriormente a dos años de seguimiento. Resultados: Se incluyeron 64 pacientes (13 hombres y 51 mujeres). La edad promedio de los hombres fue 42 años su índice de masa corporal promedio fue 49.44 kg/m², la puntuación del riesgo cardiovascular preoperatoria fue: 5.15 (2-9). Al seguimiento a dos años su índice de masa corporal promedio disminuyó a 36.23 kg/m², la puntuación del riesgo cardiovascular fue: 2.38 (0-5). En las mujeres la edad promedio fue de 36 años, su índice de masa corporal promedio previo a la cirugía fue 45.32 kg/m², la puntuación del riesgo cardiovascular fue: 4.3 (-10 a 13). A un seguimiento de dos años su índice de masa corporal promedio fue 28.64 kg/m² (20.1-42.1), la puntuación del riesgo cardiovascular fue -4.1 (-11 a 8). Conclusión: La cirugía bariátrica no sólo ha demostrado ser un método eficaz y seguro para la disminución del peso corporal en pacientes con obesidad mórbida, también aquí se demuestra que disminuye el riesgo cardiovascular que poseen estos pacientes. Abstract in english Introduction: Obesity has been considered a risk factor for acute coronary events. The main factors to develop this type of diseases are present in most of the patients subjected to bariatric surgery. Objective: To assess the cardiovascular risk of patients subjected to bariatric surgery preoperativ [...] ely and at 2-years follow-up. Setting: General Hospital ''Dr. Manuel Gea González''. Design: Retrospective, longitudinal, observational, and comparative study. Patients and methods: Patients from the bariatric surgery clinic, operated with the gastric bypass technique, calculating the cardiovascular risk preoperatively and at 2-year follow-up. Results: The study included 64 patients (13 men and 51 women). Average age of men was 42 years, their average body mass index was 49.44 kg/m², preoperative cardiovascular risk score was 5.15 (2-9). At 2-year follow-up, their BMI diminished to 36.23 kg/m², the cardiovascular risk score was 2.38 (0-5). In women, average age was of 36 years, their body mass index before surgery was of 45.32 kg/m², the cardiovascular risk score was 4.3 (-10 a 13). At 2-year follow-up, their average body mass index reduced to 28.64 kg/m² (20.1-42.1), and the cardiovascular risk score was -4.1 (-11 to 8). Conclusion: Bariatric surgery has not only been demonstrated as an efficacious and safe method to reduce body weight in patients with morbid obesity but also to diminish the cardiovascular risk depicted by these patients.

  8. Modelo predictivo de "score" de calcio alto en pacientes con factores de riesgo cardiovascular / Predictive model of high calcium score in patients with cardiovascular risk factors

    Scientific Electronic Library Online (English)

    Gloria, Franco; Samuel, Jaramillo; José Victor, de Fex; Lina M, Sierra.

    2007-12-01

    Full Text Available Introducción: a través de múltiples estudios, se ha encontrado que el "score" de calcio coronario es un buen predictor de enfermedad coronaria, en individuos asintomáticos con uno o más factores de riesgo cardiovascular. Por ello sería ideal realizar esta prueba para estratificar su riesgo, pero est [...] o no es posible en la mayoría de los casos por motivos de índole económica. El modelo que se presenta permite predecir la probabilidad de que un paciente tenga un score de calcio coronario alto, a partir de sus factores de riesgo cardiovascular. Lo novedoso del modelo es que también involucra factores "protectores" que disminuyen dicha probabilidad. Métodos: estudio de casos y controles, en pacientes asintomáticos con factores de riesgo cardiovascular, a quienes se les realizó un PCC. Los casos son pacientes con score de calcio coronario por encima del percentil 75 para su edad y género; la relación control:caso es 2:1. Resultados: las edades oscilaron entre 35 y 75 años; el 14,4% eran de género femenino, el 44,4% tenían historia familiar de CHD, el 34,4% eran hipertensos, el 38,9% colesterol total elevado, el 24,4% colesterol HDL por debajo de 40 mg/dL, el 33,3% colesterol LDL por encima de 160 mg/dL, el 25,6% fumaban, el 23,3% eran sedentarios, el 13,3% consumían licor periódicamente, el 15,6% eran obesos (IMC>30), el 18,9% realizaban ejercicio de manera periódica y 34,4% tomaba estatinas. Los factores de riesgo cardiovascular que se correlacionaron con el score de calcio coronario alto, se consignan en la tabla 1. En el modelo de regresión logística se incluyen los factores que tienen un valor de p tabla 2. La expresión para el modelo sería: Los valores de ci son 1, si el factor está presente y 0 si no lo está. Conclusiones: el anterior modelo no pretende reemplazar la estratificación con el modelo de Framingham, al contrario, es un complemento que permite orientar al médico tratante sobre si es recomendable realizar la prueba del score de calcio coronario a un paciente con factores de riesgo cardiovascular. Se puede observar que muchos de los factores de riesgo que se correlacionan con un valor elevado de "score" de calcio coronario pueden ser modificables: cesar el hábito de fumar o realizar ejercicio. Abstract in english Introduction: it has been found through multiple studies that coronary calcium score is a good predictor of coronary disease in asymptomatic individuals with one or more cardiovascular risk factors; therefore it would be ideal to perform this test in order to stratify its risk, but due to economic f [...] actors this is not possible in most cases. The model presented allows predicting the probability that a patient may have a high coronary calcium score by means of his cardiovascular risk factors. The originality of the model is that it also comprises "protector" factors that diminish such probability. Methods: study of cases and controls in asymptomatic patients with cardiovascular risk factors to whom a PCC had been performed. The cases are patients with coronary calcium score greater than percentile 75 for his age and gender; the control case relationship is 2:1. Results: ages ranged between 35 and 75 years; 14.4% were female; 44.4% had family history of CHD; 34.4% were hypertensive; 38.9% had high total cholesterol; 24.4% had HDL cholesterol under 40 mg/dl; 33.3% had LDL cholesterol greater than 160 mg/dl; 25.6% were cigarette smokers; 23.3% were sedentary; 13.3% were periodical alcohol consumers; 15.6% were obese (BMI > 30); 18.9% exercised periodically and 34.4% received statins. Cardiovascular risk factors correlated with high coronary calcium score are recorded in table 1. In the logistic regression model, factors having a p table 2 are obtained. Expression for the model would be: The values of ci values are 1, if the factor is present and 0 if it is not. Conclusions: this model does not pretend to replace stratification through Framinghan model; on the contrary, it is a complement that allows the physician to realize if the coronary calciu

  9. The ABCD and ABCD2 Scores and the Risk of Stroke following a TIA: A Narrative Review

    OpenAIRE

    Bhatt, Archit; Jani, Vishal

    2011-01-01

    The California, ABCD, and ABCD2 risk scores (ABCD system) were developed to help stratify short-term stroke risk in patients with TIA (transient ischemic attack). Beyond this scope, the ABCD system has been extensively used to study other prognostic information such as DWI (diffusion-weighted imaging) abnormalities, large artery stenosis, atrial fibrillation and its diagnostic accuracy in TIA patients, which are independent predictors of subsequent stroke in TIA patients. Our comprehensive pa...

  10. A competing risk approach for the European Heart SCORE model based on cause-specific and all-cause mortality

    DEFF Research Database (Denmark)

    Stovring, H.; Harmsen, C. G.

    2013-01-01

    Background: The European Heart SCORE model constitutes the basis for national guidelines for primary prevention and treatment of cardiovascular disease (CVD) in several European countries. The model estimates individuals' 10-year CVD mortality risks from age, sex, smoking status, systolic blood pressure, and total cholesterol level. The SCORE model, however, is not mathematically consistent and does not estimate all-cause mortality. Our aim is to modify the SCORE model to allow consistent estimation of both CVD-specific and all-cause mortality. Methods: Using a competing risk approach, we first re-estimated the cause-specific risk of dying from cardiovascular disease, and secondly we incorporated non-CVD mortality. Finally, non-CVD mortality was allowed to also depend on smoking status, and not only age and sex. From the models, we estimated CVD-specific and all-cause 10-year mortality risk, and the expected residual lifetime together with corresponding expected effects of statin treatment. Results: The modified model provided CVD-specific 10-year mortality risks similar to those of the European Heart SCORE model. Incorporation of non-CVD mortality increased 10-year mortality risks, in particular for older individuals. When non-CVD mortality was assumed unaffected by smoking status, the absolute risk reduction due to statin treatment ranged from 0.0% to 3.5%, whereas the gain in expected residual lifetime ranged from 3 to 11 months. Statin effectiveness increased for non-smokers and declined for smokers, when smoking was allowed to influence non-CVD mortality. Conclusion: The modified model provides mathematically consistent estimates of mortality risk and expected residual lifetime together with expected benefits from statin treatment.

  11. Trombo auricular derecho con riesgo embólico durante infarto agudo de miocardio / Right auricular thrombus with embolic risk during myocardial acute infarction

    Scientific Electronic Library Online (English)

    Amaury, Flores Sánchez; Damaris, Hernández-Veliz; Biolkis, Zorio Valdés; María Beatriz, Cabalé Vilariño.

    2012-03-01

    Full Text Available Un trombo móvil en la aurícula derecha implica un riesgo elevado de embolismo pulmonar y la presencia del mismo en un paciente con fibrilación auricular en el curso de un infarto agudo de miocardio, es infrecuente. Se presentó una paciente con infarto agudo de miocardio, fibrilación auricular y trom [...] bo móvil en aurícula derecha con riesgo embólico pulmonar, que desapareció luego de tratamiento antiagregante plaquetario y anticoagulante. Abstract in english A mobile thrombus into the right auricle leads to a high risk of pulmonary embolism and its presence in a patient with auricular fibrillation during a acute myocardial infarction is uncommon. This is the case of a female patient presenting with acute myocardial infarction, auricular fibrillation and [...] a mobile thrombus in right auricle with risk of pulmonary embolism, which disappeared after platelet, anticoagulant and anti-aggregating treatment.

  12. Power of IRT in GWAS: successful QTL mapping of sum score phenotypes depends on interplay between risk allele frequency, variance explained by the risk allele, and test characteristics.

    Science.gov (United States)

    van den Berg, Stéphanie M; Service, Susan K

    2012-12-01

    As data from sequencing studies in humans accumulate, rare genetic variants influencing liability to disease and disorders are expected to be identified. Three simulation studies show that characteristics and properties of diagnostic instruments interact with risk allele frequency to affect the power to detect a quantitative trait locus (QTL) based on a test score derived from symptom counts or questionnaire items. Clinical tests, that is, tests that show a positively skewed phenotypic sum score distribution in the general population, are optimal to find rare risk alleles of large effect. Tests that show a negatively skewed sum score distribution are optimal to find rare protective alleles of large effect. For alleles of small effect, tests with normally distributed item parameters give best power for a wide range of allele frequencies. The item-response theory framework can help understand why an existing measurement instrument has more power to detect risk alleles with either low or high frequency, or both kinds. PMID:22965845

  13. Microbial Translocation in HIV Infection is Associated with Dyslipidemia, Insulin Resistance, and Risk of Myocardial Infarction

    DEFF Research Database (Denmark)

    Pedersen, Karin Kaereby; Pedersen, Maria

    2013-01-01

    Microbial translocation has been suggested to be a driver of immune activation and inflammation. We hypothesized that microbial translocation may be related to dyslipidemia, insulin resistance, and the risk of coronary heart disease in HIV-infected individuals.

  14. Improved risk stratification by the integration of the revised international prognostic scoring system with the myelodysplastic syndromes comorbidity index.

    Science.gov (United States)

    van Spronsen, M F; Ossenkoppele, G J; Holman, R; van de Loosdrecht, A A

    2014-12-01

    Myelodysplastic syndromes (MDS) comprise bone marrow failure diseases with a diverse clinical outcome. For improved risk stratification, the International Prognostic Scoring System (IPSS) has recently been revised (IPSS-R). This single-centre study aimed to validate the IPSS-R and to evaluate prior prognostic scoring systems for MDS. We retrospectively analysed 363 patients diagnosed with MDS according to the FAB criteria between 2000 and 2012. The IPSS, MD Anderson Risk Model Score (MDAS), World Health Organisation (WHO)-classification based Prognostic Scoring System (WPSS), refined WPSS (WPSS-R), IPSS-R and MDS-Comorbidity Index (MDS-CI) were applied to 222 patients considered with primary MDS following the WHO criteria and their prognostic power was investigated. According to the IPSS-R, 18 (8%), 81 (37%), 50 (23%), 43 (19%) and 30 (13%) patients were classified as very low, low, intermediate, high and very high risk with, respectively, a median overall survival of 96 (95% Confidence interval (CI) not reached), 49 (95% CI 34-64), 22 (95% CI 0-49), 19 (95% CI 11-27) and 10 (95% CI 6-13) months (pMDAS, WPSS and WPSS-R. Furthermore, the MDS-CI refined the risk stratification of MDS patients stratified according to the IPSS-R. In conclusion, accounting for the disease status by means of the IPSS-R and comorbidity through the MDS-CI considerably improves the prognostic assessment in MDS patients. PMID:25454415

  15. Models of Assessment of the Credit Risk of Borrowers with a Time Parameter for the Systems of Application Credit Scoring ?????? ?????? ?????????? ????? ????????? ? ????????? ?????????? ??? ?????? ??????????????? ?????????? ????????

    Directory of Open Access Journals (Sweden)

    Pisanets Konstantin K.

    2013-07-01

    Full Text Available The article considers a concept of introduction of the time factor into the models of application credit scoring as a key characteristic of a default level. Using example of data of the consumption segment of the credit market of Ukraine, the article presents results of modelling the credit risk of potential borrowers (applicants, using approaches of Kaplan-Meier and Cox.? ?????? ??????????? ????????? ???????? ??????? ??????? ? ?????? ??????????????? ?????????? ???????? ??? ???????? ?????????????? ?????? ???????. ?? ??????? ?????? ???????????????? ???????? ?????????? ????? ??????? ???????????? ?????????? ????????????? ?????????? ????? ????????????? ????????? (???????????, ????????? ??????? ???????-?????? ? ?????.

  16. Olson method for locating and calculating the extent of transmural ischemic areas at risk of infarction

    DEFF Research Database (Denmark)

    Olson, Charles W; Wagner, Galen S

    2014-01-01

    OBJECTIVES: The purpose of this study is to present a new and improved method for translating the electrocardiographic changes of acute myocardial ischemia into a display which reflects the location and extent of the ischemic area and the associated culprit coronary artery. This method could be automated to present a graphic image of the ischemic area in a manner understandable by all levels of caregivers; from emergency transport personnel to the consulting cardiologist. BACKGROUND: Current methods for the ECG diagnosis of ST elevated myocardial infarction (STEMI) are criteria driven, and complex, and beyond the interpretive capability of many caregivers. New methods are needed to accurately diagnose the presence of acute transmural myocardial ischemia in order to accelerate a patient's clinical "door to balloon time." The proposed new method could potentially provide the information needed to accomplish this objective. METHODS: The new method improves the precision of diagnosis and quantification of ischemia by normalizing the ST segment inputs from the standard 12 lead ECG, transforming these into a three dimensional vector representation of the ischemia at the electrical center of the heart. The myocardial areas likely to be involved in this ischemia are separately analyzed to assess the probability that they contributed to this event. The source of the ischemia is revealed as a specific region of the heart, and the likely location of the associated culprit coronary artery. Seventy 12 lead ECGs from subjects with known single artery occlusion in one of the three main coronary arteries were selected to test this new method. Graphic plots of the distribution of ischemia as indicated by the method are consistent with the known occlusion. The analysis of the distribution of ischemic areas in the myocardium reveals that the relationships between leads with either ST elevation or ST depression, provide critical information improving the current method.

  17. Association of the eNOS E298D polymorphism and the risk of myocardial infarction in the Greek population

    Directory of Open Access Journals (Sweden)

    Reczko Martin

    2010-09-01

    Full Text Available Abstract Background Nitric oxide (NO, produced by endothelial nitric oxide synthase (eNOS, plays a key role in the regulation of vascular tone. Endothelium-derived NO exerts vasoprotective effects by suppressing platelet aggregation, leukocyte adhesion and smooth muscle cell proliferation. The E298D polymorphic variant of eNOS has been associated with myocardial infarction (MI, but data relating to this variant are divergent in Greece. Accordingly, we examined a possible association between the E298D polymorphism of the eNOS gene and MI in a subgroup of the Greek population. Methods The study population consisted of 204 patients with a history of MI and 218 control subjects. All subjects were of Greek origin and were selected from the general population of the greater Athens area. Genotyping was performed with melting curve analysis (Lightcycler system of polymerase chain reaction amplified products using hybridization probes. Results According to the univariate findings, the risk for MI in E298D TT was 2.06 (95%CI: 1.06-4.00, p = 0.032 versus GG+GT and 2.34 (95%CI: 1.17-4.68, p = 0.016 versus GG. The risk for the T allele was estimated at 1.42 (95%CI, 1.06-1.89, p = 0.022 as compared to G allele. Regarding the additive model, one allele increase was associated with 43% higher risk of MI (OR = 1.43, 95%CI: 1.07-1.93, p = 0.018 as compared to the baseline category of homozygous GG. The positive association of TT versus GG+GT with MI risk remained even after adjusting for the main study covariates. Moreover, strong evidence was found for an increased risk for MI among carriers of the TT genotype who were smokers, hypertensive and had a family history of CAD. Conclusions This study indicates that E298D polymorphism of the eNOS gene seems to be associated with MI occurrence in the Greek population. It is possible that TT genotype is closely linked to the etiology of MI even after adjusting for known MI risk factors.

  18. Association of NSAID use with risk of bleeding and cardiovascular events in patients receiving antithrombotic therapy after myocardial infarction

    DEFF Research Database (Denmark)

    Schjerning Olsen, Anne-Marie; Gislason, Gunnar H

    2015-01-01

    IMPORTANCE: Antithrombotic treatment is indicated for use in patients after myocardial infarction (MI); however, concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) could pose safety concerns. OBJECTIVE: To examine the risk of bleeding and cardiovascular events among patients with prior MI taking antithrombotic drugs and for whom NSAID therapy was then prescribed. DESIGN, SETTING, AND PARTICIPANTS: Using nationwide administrative registries in Denmark (2002-2011), we studied patients 30 years or older admitted with first-time MI and alive 30 days after discharge. Subsequent treatment with aspirin, clopidogrel, or oral anticoagulants and their combinations, as well as ongoing concomitant NSAID use, was determined. EXPOSURES: Use of NSAIDs with ongoing antithrombotic treatment after first-time MI. MAIN OUTCOMES AND MEASURES: Risk of bleeding (requiring hospitalization) or a composite cardiovascular outcome (cardiovascular death, nonfatal recurrent MI, and stroke) according to ongoing NSAID and antithrombotic therapy, calculated using adjusted time-dependent Cox regression models. RESULTS: We included 61,971 patients (mean age, 67.7 [SD, 13.6] years; 63% men); of these, 34% filled at least 1 NSAID prescription. The number of deaths during a median follow-up of 3.5 years was 18,105 (29.2%). A total of 5288 bleeding events (8.5%) and 18,568 cardiovascular events (30.0%) occurred. The crude incidence rates of bleeding (events per 100 person-years) were 4.2 (95% CI, 3.8-4.6) with concomitant NSAID treatment and 2.2 (95% CI, 2.1-2.3) without NSAID treatment, whereas the rates of cardiovascular events were 11.2 (95% CI, 10.5-11.9) and 8.3 (95% CI, 8.2-8.4). The multivariate-adjusted Cox regression analysis found increased risk of bleeding with NSAID treatment compared with no NSAID treatment (hazard ratio, 2.02 [95% CI, 1.81-2.26]), and the cardiovascular risk was also increased (hazard ratio, 1.40 [95% CI, 1.30-1.49]). An increased risk of bleeding and cardiovascular events was evident with concomitant use of NSAIDs, regardless of antithrombotic treatment, types of NSAIDs, or duration of use. CONCLUSIONS AND RELEVANCE: Among patients receiving antithrombotic therapy after MI, the use of NSAIDs was associated with increased risk of bleeding and excess thrombotic events, even after short-term treatment. More research is needed to confirm these findings; however, physicians should exercise appropriate caution when prescribing NSAIDs for patients who have recently experienced MI.

  19. Myocardium at risk after acute infarction in humans on cardiac magnetic resonance: quantitative assessment during follow-up and validation with single-photon emission computed tomography.

    OpenAIRE

    Carlsson, Marcus; Ubachs, Joey; Hedström, Erik; Heiberg, Einar; Jovinge, Stefan; Arheden, Håkan

    2009-01-01

    OBJECTIVES: Our goal was to validate myocardium at risk on T2-weighted short tau inversion recovery (T2-STIR) cardiac magnetic resonance (CMR) over time, compared with that seen with perfusion single-photon emission computed tomography (SPECT) in patients with ST-segment elevation myocardial infarction, and to assess the amount of salvaged myocardium after 1 week. BACKGROUND: To assess reperfusion therapy, it is necessary to determine how much myocardium is salvaged by measuring the final inf...

  20. Myocardial infarction and diabetes mellitus : Studies on glucose lowering therapies and novel risk markers based on observations from the DIGAMI 2 trial

    OpenAIRE

    Mellbin, Linda Garcia

    2010-01-01

    Background Patients with myocardial infarction (MI) and type 2 diabetes (T2DM) and have a poor prognosis. Hyperglycemia is an independent risk predictor. The best tools for glucose control are debated. Important is identification of biomarkers to gain further pathophysiological insights and new therapeutic possibilities. Aims In patients with acute MI and T2DM 1. Explore the prognostic impact of hypoglycemia during hospitalization for MI 2. Study the prognostic ...

  1. Cancer of the Prostate Risk Assessment (CAPRA) Preoperative Score Versus Postoperative Score (CAPRA-S): ability to predict cancer progression and decision-making regarding adjuvant therapy after radical prostatectomy.

    Science.gov (United States)

    Seo, Won Ik; Kang, Pil Moon; Kang, Dong Il; Yoon, Jang Ho; Kim, Wansuk; Chung, Jae Il

    2014-09-01

    The University of California, San Francisco, announced in 2011 Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score which included pathologic data, but there were no results for comparing preoperative predictors with the CAPRA-S score. We evaluated the validation of the CAPRA-S score in our institution and compare the result with the preoperative progression predictor, CAPRA score. Data of 130 patients were reviewed who underwent radical prostatectomy for localized prostate cancer from 2008 to 2013. Performance of CAPRA-S score in predicting progression free probabilities was assessed through Kaplan Meier analysis and Cox proportional hazards regression test. Additionally, prediction probability was compared with preoperative CAPRA score by logistic regression analysis. Comparing CAPRA score, the CAPRA-S score showed improved prediction ability for 5 yr progression free survival (concordance index 0.80, P = 0.04). After risk group stratification, 3 group model of CAPRA-S was superior than 3 group model of CAPRA for 3-yr progression free survival and 5-yr progression free survival (concordance index 0.74 vs. 0.70, 0.77 vs. 0.71, P < 0.001). Finally the CAPRA-S score was the more ideal predictor concerned with adjuvant therapy than the CAPRA score through decision curve analysis. The CPARA-S score is a useful predictor for disease progression after radical prostatectomy. PMID:25246738

  2. Is High Modified Mallampati Score A Risk Factor for Arterial Hypertension?

    Directory of Open Access Journals (Sweden)

    Güçlü Beriat

    2012-07-01

    Full Text Available Aim: Various studies have shown that one of these predisposing risk factors, namely the anatomical narrowness of the upper airway, is linked to insulin resistance, atherosclerosis, obesity, and HT related diseases. This study investigates the possible relation between HT and the Modified Mallampati Score (MMS which is linked to the anatomical narrowness of the upper airway at the oropharynx level. Material and Method: The study covers a total of 138 adults of which 57 are women (41.3% and 81 are men (58.7%. The patients were selected among those adults who had presented to the cardiology clinic with a known history of hypertension, without any systemic diseases, not on medication for any reason, and without any anatomical problems that could give way to airway obstruction through a detailed ENT examination. Results: According to MMS the mean figures of systolic and diastolic blood there was a statistically significant relation between HT and MMS (p<0.05. There was also a statistically significant difference between the systolic and diastolic blood pressures of patients with MMS1-MMS2, MMS1-MMS3. The same relation was found between MMS2-MMS3 only regarding the diastolic pressures (p<0.017. Discussion: It is shown that high MMS is related to HT. We think that it would be best for high MMS patients be evaluated concerning HT during the initial examination of the patient by the clinician.

  3. Does Preendoscopy Rockall Score Safely Identify Low Risk Patients following Upper Gastrointestinal Haemorrhage?

    Science.gov (United States)

    Johnston, Matthew R; Murray, Iain A; Schultz, Michael; McLeod, Peter; O'Donnell, Nathan; Norton, Heather; Baines, Chelsea; Fawcett, Emily; Fesaitu, Terry; Leung, Hin; Park, Jeong-Yoon; Salleh, Adibah; Zhang, Wei; García, José A

    2015-01-01

    Objective. To determine if preendoscopy Rockall score (PERS) enables safe outpatient management of New Zealanders with upper gastrointestinal haemorrhage (UGIH). Methods. Retrospective analysis of adults with UGIH over 59 consecutive months. PERS, diagnosis, demographics, need for endoscopic therapy, transfusion or surgery and 30-day mortality and 14-day rebleeding rate, and sensitivity and specificity of PERS for enabling safe discharge preendoscopy were calculated. Results. 424 admissions with UGIH. Median age was 74.3 years (range 19-93 years), with 55.1% being males. 30-day mortality was 4.6% and 14-day rebleeding rate was 6.0%. Intervention was required in 181 (46.6%): blood transfusion (147?:?37.9%), endoscopic intervention (75?:?19.3%), and surgery (8?:?2.1%). 42 (10.8%) had PERS = 0 with intervention required in 15 (35.7%). Females more frequently required intervention, OR 1.73 (CI: 1.12-2.69). PERS did not predict intervention but did predict 30-day mortality: each point increase equated to an increase in mortality of OR 1.46 (CI: 1.11-1.92). Taking NSAIDs/aspirin reduced 30-day mortality, OR 0.22 (CI: 0.08-0.60). Conclusion. PERS identifies 10.8% of those with UGIH as low risk but 35.7% required intervention or died. It has a limited role in assessing these patients and should not be used to identify those suitable for outpatient endoscopy. PMID:26089867

  4. Renal infarction

    Directory of Open Access Journals (Sweden)

    Saeed K

    2012-09-01

    Full Text Available Khawer SaeedMemorial University of Newfoundland, St John's, Newfoundland, CanadaAbstract: Renal infarction is an underdiagnosed and under-reported phenomenon, and needs to be diagnosed rapidly to prevent permanent loss of renal function. Renal infarction should be considered in the initial differential diagnosis of nephrolithiasis and pyelonephritis. It is often mistaken for more benign pathology and is worthwhile reviewing and reporting.Keywords: renal infarction, diagnosis, atrial fibrillation

  5. Mental health status and risk of new cardiovascular events or death in patients with myocardial infarction: a population-based cohort study

    Science.gov (United States)

    Nielsen, Tine Jepsen; Vestergaard, Mogens; Christensen, Bo; Christensen, Kaj Sparle; Larsen, Karen Kjær

    2013-01-01

    Objective To examine the association between mental health status after first-time myocardial infarction (MI) and new cardiovascular events or death, taking into account depression and anxiety as well as clinical, sociodemographic and behavioural risk factors. Design Population-based cohort study based on questionnaires and nationwide registries. Mental health status was assessed 3?months after MI using the Mental Component Summary score from the Short-Form 12 V.2. Setting Central Denmark Region. Participants All patients hospitalised with first-time MI from 1 January 2009 through 31 December 2009 (n=880). The participants were categorised in quartiles according to the level of mental health status (first quartile=lowest mental health status). Main outcome measures Composite endpoint of new cardiovascular events (MI, heart failure, stroke/transient ischaemic attack) and all-cause mortality. Results During 1940 person-years of follow-up, 277 persons experienced a new cardiovascular event or died. The cumulative incidence following 3?years after MI increased consistently with decreasing mental health status and was 15% (95% CI 10.8% to 20.5%) for persons in the fourth quartile, 29.1% (23.5% to 35.6%) in the third quartile, 37.0% (30.9% to 43.9%) in the second quartile, and 47.5% (40.9% to 54.5%) in the first quartile. The HRs were high, even after adjustments for age, sociodemographic characteristics, cardiac disease severity, comorbidity, secondary prophylactic medication, smoking status, physical activity, depression and anxiety (HR3rd quartile 1.90 (95% CI 1.23 to 2.93), HR2nd quartile 2.14 (1.37 to 3.33), HR1st quartile 2.23 (1.35 to 3.68) when using the fourth quartile as reference). Conclusions Low mental health status following first-time MI was independently associated with an increased risk of new cardiovascular events or death. Further research is needed to disentangle the pathways that link mental health status following MI to prognosis and to identify interventions that can improve mental health status and prognosis. PMID:23913773

  6. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H

    2014-01-01

    BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n?=?16?827). In total, 1787 (10.6%) died within 30?days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute surgery, and body mass index category the following variables predicted mortality (points): male gender (1), age 56-65?years (2), age 66-75?years (4), age 76-85?years (5), or age >85?years (7), being underweight (4), normal weight (3), or overweight (1), undergoing acute surgery (5), undergoing high-risk procedures (intra-thoracic, intra-abdominal, or suprainguinal aortic) (3), having renal disease (1), cerebrovascular disease (1), and use of insulin (1). The c-statistic was 0.79 and calibration was good. Mortality risk ranged from 50% for a score ?20. Internal validation by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P?risk for perioperative mortality.

  7. A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H

    2014-01-01

    BACKGROUND: Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. METHODS AND RESULTS: All individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n?=?16?827). In total, 1787 (10.6%) died within 30?days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute surgery, and body mass index category the following variables predicted mortality (points): male gender (1), age 56-65?years (2), age 66-75?years (4), age 76-85?years (5), or age >85?years (7), being underweight (4), normal weight (3), or overweight (1), undergoing acute surgery (5), undergoing high-risk procedures (intra-thoracic, intra-abdominal, or suprainguinal aortic) (3), having renal disease (1), cerebrovascular disease (1), and use of insulin (1). The c-statistic was 0.79 and calibration was good. Mortality risk ranged from 50% for a score ?20. Internal validation by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P?risk for perioperative mortality.

  8. Combined Biomarker Analysis for Risk of Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction

    Science.gov (United States)

    Tung, Ying-Chang; Chang, Chih-Hsiang; Chen, Yung-Chang; Chu, Pao-Hsien

    2015-01-01

    Background Acute kidney injury (AKI) complicating ST-segment elevation myocardial infarction (STEMI) increases subsequent morbidity and mortality. We combined the biomarkers of heart failure (HF; B-type natriuretic peptide [BNP] and soluble ST2 [sST2]) and renal injury (NGAL [neutrophil gelatinase-associated lipocalin] and cystatin C) in predicting the development of AKI in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Methods and Results From March 2010 to September 2013, 189 STEMI patients were sequentially enrolled and serum samples were collected at presentation for BNP, sST2, NGAL and cystatin C analysis. 37 patients (19.6%) developed AKI of varying severity within 48 hours of presentation. Univariate analysis showed age, Killip class ?2, hypertension, white blood cell counts, hemoglobin, estimated glomerular filtration rate, blood urea nitrogen, creatinine, and all the four biomarkers were predictive of AKI. Serum levels of the biomarkers were correlated with risk of AKI and the Acute Kidney Injury Network (AKIN) stage and all significantly discriminated AKI (area under the receiver operating characteristic [ROC] curve: BNP: 0.86, sST2: 0.74, NGAL: 0.75, cystatin C: 0.73; all P < 0.05). Elevation of ?2 of the biomarkers higher than the cutoff values derived from the ROC analysis improved AKI risk stratification, regardless of the creatine level (creatinine < 1.24 mg/dL: odds ratio [OR] 11.25, 95% confidence interval [CI] 1.63-77.92, P = 0.014; creatinine ? 1.24: OR 15.0, 95% CI 1.23-183.6, P = 0.034). Conclusions In this study of STEMI patients undergoing primary PCI, the biomarkers of heart failure (BNP and sST2) and renal injury (NGAL and cystatin C) at presentation were predictive of AKI. High serum levels of the biomarkers were associated with an elevated risk and more advanced stage of AKI. Regardless of the creatinine level, elevation of ?2 of the biomarkers higher than the cutoff values indicated a further rise in AKI risk. Combined biomarker approach may assist in risk stratification of AKI in patients with STEMI. PMID:25853556

  9. Dental prophylaxis decreases the risk of acute myocardial infarction: a nationwide population-based study in Taiwan

    Directory of Open Access Journals (Sweden)

    Lee YL

    2015-01-01

    Full Text Available Ya-Ling Lee,1,2 Hsiao-Yun Hu,2,3 Pesus Chou,2 Dachen Chu2,4,5 1Department of Dentistry, Taipei City Hospital, 2Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, 3Department of Education and Research, Taipei City Hospital, 4Department of Health Care Management, National Taipei University of Nursing and Health Sciences, 5Department of Neurosurgery, Taipei City Hospital, Taipei, Taiwan Purpose: To investigate the association between periodontal disease (PD and acute ­myocardial infarction (AMI, and evaluate the effect of dental prophylaxis on the incidence rate (IR of AMI.Methods: The Longitudinal Health Insurance Database 2000 from the National Health Insurance program was used to identify 511,630 patients with PD and 208,713 without PD during 2000–2010. Subjects with PD were grouped according to treatment (dental prophylaxis, intensive treatment, and PD without treatment. The IRs of AMI during the 10-year follow-up period were compared among groups. Cox regression analysis adjusted for age, sex, socioeconomic status, residential urbanicity, and comorbidities was used to evaluate the effect of PD treatment on the incidence of AMI.Results: The IR of AMI among subjects without PD was 0.19%/year. Among those with PD, the IR of AMI was lowest in the dental prophylaxis group (0.11%/year, followed by the intensive treatment (0.28%/year and PD without treatment (0.31%/year; P<0.001 groups. Cox regression showed that the hazard ratio (HR for AMI was significantly lower in the dental prophylaxis group (HR =0.90, 95% confidence interval =0.86–0.95 and higher in the intensive treatment (HR =1.09, 95% confidence interval =1.03–1.15 and PD without treatment (HR =1.23, 95% confidence interval =1.13–1.35 groups than in subjects without PD.Conclusion: PD is associated with a higher risk of AMI, which can be reduced by dental prophylaxis to maintain periodontal health. Keywords: periodontal disease, acute myocardial infarction, dental prophylaxis, dental scaling

  10. Fatty acid desaturase gene variants, cardiovascular risk factors, and myocardial infarction in the costa rica study

    Science.gov (United States)

    Genetic variation in fatty acid desaturases (FADS) has previously been linked to long-chain polyunsaturated fatty acids (PUFAs) in adipose tissue and cardiovascular risk. The goal of our study was to test associations between six common FADS polymorphisms (rs174556, rs3834458, rs174570, rs2524299, r...

  11. Validation of a modified clinical risk score to predict cancer-specific survival for stage II colon cancer.

    Science.gov (United States)

    Oliphant, Raymond; Horgan, Paul G; Morrison, David S; McMillan, Donald C

    2015-01-01

    Many patients with stage II colon cancer will die of their disease despite curative surgery. Therefore, identification of patients at high risk of poor outcome after surgery for stage II colon cancer is desirable. This study aims to validate a clinical risk score to predict cancer-specific survival in patients undergoing surgery for stage II colon cancer. Patients undergoing surgery for stage II colon cancer in 16 hospitals in the West of Scotland between 2001 and 2004 were identified from a prospectively maintained regional clinical audit database. Overall and cancer-specific survival rates up to 5 years were calculated. A total of 871 patients were included. At 5 years, cancer-specific survival was 81.9% and overall survival was 65.6%. On multivariate analysis, age ?75 years (hazard ratio (HR) 2.11, 95% confidence intervals (CI) 1.57-2.85; Prisk score of 0-2. The cancer-specific survival at 5 years for patients with a cumulative score 0 was 88.7%, 1 was 78.2% and 2 was 65.9%. These results validate a modified simple clinical risk score for patients undergoing surgery for stage II colon cancer. The combination of these two universally documented clinical factors provides a solid foundation for the examination of the impact of additional clinicopathological and treatment factors on overall and cancer-specific survival. PMID:25487740

  12. Detection of lipid-core plaques by intracoronary near-infrared spectroscopy identifies high risk of periprocedural myocardial infarction.

    LENUS (Irish Health Repository)

    Goldstein, James A

    2012-02-01

    BACKGROUND: Percutaneous coronary intervention (PCI) is associated with periprocedural myocardial infarction (MI) in 3% to 15% of cases (depending on the definition used). In many cases, these MIs result from distal embolization of lipid-core plaque (LCP) constituents. Prospective identification of LCP with catheter-based near-infrared spectroscopy (NIRS) may predict an increased risk of periprocedural MI and facilitate development of preventive measures. METHODS AND RESULTS: The present study analyzed the relationship between the presence of a large LCP (detected by NIRS) and periprocedural MI. Patients with stable preprocedural cardiac biomarkers undergoing stenting were identified from the COLOR Registry, an ongoing prospective observational study of patients undergoing NIRS before PCI. The extent of LCP in the treatment zone was calculated as the maximal lipid-core burden index (LCBI) measured by NIRS for each of the 4-mm longitudinal segments in the treatment zone. A periprocedural MI was defined as new cardiac biomarker elevation above 3x upper limit of normal. A total of 62 patients undergoing stenting met eligibility criteria. A large LCP (defined as a maxLCBI(4 mm) >\\/=500) was present in 14 of 62 lesions (22.6%), and periprocedural MI was documented in 9 of 62 (14.5%) of cases. Periprocedural MI occurred in 7 of 14 patients (50%) with a maxLCBI(4 mm) >\\/=500, compared with 2 of 48 patients (4.2%) patients with a lower maxLCBI(4 mm) (P=0.0002). CONCLUSIONS: NIRS provides rapid, automated detection of extensive LCPs that are associated with a high risk of periprocedural MI, presumably due to embolization of plaque contents during coronary intervention.

  13. Relation of ST-segment elevation before and after percutaneous transluminal coronary angioplasty to left ventricular area at risk, myocardial infarct size, and systolic function.

    Science.gov (United States)

    Rodríguez-Palomares, José F; Figueras-Bellot, Jaume; Descalzo, Martin; Moral, Sergio; Moral, Sergi; Otaegui, Imanol; Pineda, Victor; Del Blanco, Bruno García; González-Alujas, Maria T; Evangelista Masip, Artur; García-Dorado, David

    2014-02-15

    Electrocardiography is an excellent tool for decision making in patients with ST elevation myocardial infarction (STEMI). However, little is known on the correlation between its dynamic changes during primary percutaneous coronary intervention (PCI) and the anatomic information provided by cardiovascular magnetic resonance. The study aimed to assess the predictive value of dynamic ST-segment changes before and after PCI on myocardial area at risk (AAR), infarct size, and left ventricular function in patients with STEMI. Eighty-five consecutive patients with a first STEMI were included. An electrocardiogram was recorded before and after PCI at 1, 24, 48, 72, and 120 hours. Sum of ST elevation (sumSTE), the number of STE, and STE resolution (resSTE) were determined. Complete resSTE was defined as ?70% resolution, and patients were classified into 3 groups: group 1 (resSTE 1 hour after PCI) n = 39; group 2 (resSTE 120 hour after PCI) n = 27; and group 3, without resSTE (n = 19). Cardiovascular magnetic resonance was performed during hospitalization and at 6 months. Left ventricular volumes, ejection fraction, AAR, infarct size, myocardial salvage index, and microvascular obstruction were determined. Before PCI, the number of STE and sumSTE were best associated with AAR (p MVO, and lower myocardial salvage index. However, sumSTE at 120 hours after PCI best discriminated patients with larger infarct size, ventricular volumes, and lower ejection fraction during hospitalization and at follow-up. In conclusion, admission sumSTE best correlates with AAR, whereas sumSTE at 120 hours rather than early resSTE best correlates with infarct size and left ventricular volumes during hospitalization and at 6 months. PMID:24484860

  14. Clinical discriminators between acute brain hemorrhage and infarction: a practical score for early patient identification Características clínicas diferenciais entre hemorragia e infarto cerebral: uma escala prática para identificação precoce do paciente

    Directory of Open Access Journals (Sweden)

    Ayrton R. Massaro

    2002-06-01

    Full Text Available New treatments for acute stroke require a rapid triage system, which minimizes treatment delays and maximizes selection of eligible patients. Our aim was to create a score for assessing the probability of brain hemorrhage among patients with acute stroke based upon clinical information. Of 1805 patients in the Stroke Data Bank, 1273 had infarction (INF and 237 had parenchymatous hemorrhage (HEM verified by CT. INF and HEM discriminators were determined by logistic regression and used to create a score. ROC curve was used to choose the cut-point for predicting HEM (score Novas perspectivas no tratamento do acidente vascular cerebral (AVC requerem um método de triagem rápido para seleção dos pacientes. Nosso objetivo foi criar uma escala com informações clínicas simples para diferenciar hematoma intra-parenquimatoso (HEM entre os pacientes com AVC. Estudamos 1.273 pacientes com AVC isquêmico (INF e 237 com HEM do Stroke Data Bank. Variáveis independentes para o diagnóstico de INF e HEM foram determinadas pela análise de regressão logística e utilizadas para criar uma escala. Através da curva ROC foi escolhido o nível de corte para discriminar HEM (<= 2 , com sensibilidade de 76%, especificidade de 83%. Foi realizada validação externa utilizando os pacientes do estudo NOMASS. Embora o uso de uma escala de fácil aplicação pelas equipes de emergência não possa substituir os métodos de imagem na diferenciação entre INF e HEM para a indicação de trombolítico, a escala proposta pode ser útil para selecionar pacientes para estudos clínicos e tratamento pré-hospitalar, alertar técnicos de tomografia e as equipes médicas sobre a chegada de pacientes, contribuindo para reduzir atrasos cruciais no tratamento.

  15. Family history of myocardial infarction as an independent risk factor for coronary heart disease.

    OpenAIRE

    Friedlander, Y.; Kark, J. D.; Stein, Y.

    1985-01-01

    The hypothesis that a family history of heart attack before the age of 60 years is an independent risk factor for coronary heart disease was examined in a random sample of 1044 men aged 40-70. Data on personal and family history, smoking, weight, height, plasma lipid and lipoprotein concentrations, blood pressure, and resting and exercise electrocardiograms were collected according to the standard Lipid Research Clinics protocol. A history of heart attack in first degree relatives was ascerta...

  16. The Patient- And Nutrition-Derived Outcome Risk Assessment Score (PANDORA): Development of a Simple Predictive Risk Score for 30-Day In-Hospital Mortality Based on Demographics, Clinical Observation, and Nutrition

    Science.gov (United States)

    Frantal, Sophie; Schindler, Karin; Themessl-Huber, Michael; Mouhieddine, Mohamed; Schuh, Christian; Pernicka, Elisabeth; Schneider, Stéphane; Singer, Pierre; Ljunqvist, Olle; Pichard, Claude; Laviano, Alessandro; Kosak, Sigrid

    2015-01-01

    Objective To develop a simple scoring system to predict 30 day in-hospital mortality of in-patients excluding those from intensive care units based on easily obtainable demographic, disease and nutrition related patient data. Methods Score development with general estimation equation methodology and model selection by P-value thresholding based on a cross-sectional sample of 52 risk indicators with 123 item classes collected with questionnaires and stored in an multilingual online database. Setting Worldwide prospective cross-sectional cohort with 30 day in-hospital mortality from the nutritionDay 2006-2009 and an external validation sample from 2012. Results We included 43894 patients from 2480 units in 32 countries. 1631(3.72%) patients died within 30 days in hospital. The Patient- And Nutrition-Derived Outcome Risk Assessment (PANDORA) score predicts 30-day hospital mortality based on 7 indicators with 31 item classes on a scale from 0 to 75 points. The indicators are age (0 to 17 points), nutrient intake on nutritionDay (0 to 12 points), mobility (0 to 11 points), fluid status (0 to 10 points), BMI (0 to 9 points), cancer (9 points) and main patient group (0 to 7 points). An appropriate model fit has been achieved. The area under the receiver operating characteristic curve for mortality prediction was 0.82 in the development sample and 0.79 in the external validation sample. Conclusions The PANDORA score is a simple, robust scoring system for a general population of hospitalised patients to be used for risk stratification and benchmarking. PMID:26000634

  17. Venous infarctions

    International Nuclear Information System (INIS)

    Strokes of venous origin are relatively infrequent. They usually cause venous infarcts which can be observed in 2 main circumstances: cerebral thrombophlebitis or dural arteriovenous (AV) fistulae draining into cerebral veins. The authors study the CT and angiographic aspects of these venous infarcts and their evolution. Conventional angiography remains indispensible to confirm the diagnosis

  18. Agreement between the SCORE and D’Agostino Scales for the Classification of High Cardiovascular Risk in Sedentary Spanish Patients

    Directory of Open Access Journals (Sweden)

    Luis García-Ortiz

    2009-11-01

    Full Text Available Background: To evaluate agreement between cardiovascular risk in sedentary patients as estimated by the new Framingham-D’Agostino scale and by the SCORE chart, and to describe the patient characteristics associated with the observed disagreement between the scales. Design: A cross-sectional study was undertaken involving a systematic sample of 2,295 sedentary individuals between 40–65 years of age seen for any reason in 56 primary care offices. An estimation was made of the Pearson correlation coefficient and kappa statistic for the classification of high risk subjects (?20% according to the Framingham-D’Agostino scale, and ?5% according to SCORE. Polytomous logistic regression models were fitted to identify the variables associated with the discordance between the two scales. Results: The mean risk in males (35% was 19.5% ± 13% with D’Agostino scale, and 3.2% ± 3.3% with SCORE. Among females, they were 8.1% ± 6.8% and 1.2% ± 2.2%, respectively. The correlation between the two scales was 0.874 in males (95% CI: 0.857–0.889 and 0.818 in females (95% CI: 0.800–0.834, while the kappa index was 0.50 in males (95% CI: 0.44%–0.56% and 0.61 in females (95% CI: 0.52%–0.71%. The most frequent disagreement, characterized by high risk according to D’Agostino scale but not according to SCORE, was much more prevalent among males and proved more probable with increasing age and increased LDL-cholesterol, triglyceride and systolic blood pressure values, as well as among those who used antihypertensive drugs and smokers. Conclusions: The quantitative correlation between the two scales is very high. Patient categorization as corresponding to high risk generates disagreements, mainly among males, where agreement between the two classifications is only moderate.

  19. The Value of the European Society of Cardiology Guidelines for Refining Stroke Risk Stratification in Patients With Atrial Fibrillation Categorized as Low Risk Using the Anticoagulation and Risk Factors in Atrial Fibrillation Stroke Score : A Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Lip, Gregory Y H; Nielsen, Peter BrØnnum

    2014-01-01

    BACKGROUND: Our objective was to determine stroke and thromboembolism event rates in patients with atrial fibrillation (AF) classified as "low risk" using the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) score and to ascertain event rates in this group in relation to the stroke risk assessment advocated in the 2012 European Society of Cardiology (ESC) guidelines (based on the CHA2DS2-VASc [congestive heart failure, hypertension, age ? 75 years, diabetes, previous stroke/transient ischemic attack, vascular disease, age 65 to 74 years, sex category] score). We tested the hypothesis that the stroke risk assessment scheme advocated in the ESC guidelines would be able to further refine stroke risk stratification in the low-risk category defined by the ATRIA score. METHODS: In our cohort of 207,543 incident patients with AF from 1999 to 2012, we identified 72,452 subjects who had an ATRIA score of 0 to 5 (low risk). RESULTS: Even among these patients categorized as low risk using the ATRIA score, the 1-year stroke/thromboembolic event rate ranged from 1.13 to 36.94 per 100 person-years, when subdivided by CHA2DS2-VASc scores. In patients with an ATRIA score 0 to 5, C statistics at 1 year follow-up in the Cox regression model were significantly improved from 0.626 (95% CI, 0.612-0.640) to 0.665 (95% CI, 0.651-0.679) when the CHA2DS2-VASc score was used for categorizing stroke risk instead of the ATRIA score (P < .001). CONCLUSIONS: Patients categorized as low risk using an ATRIA score 0 to 5 are not necessarily low risk, with 1-year event rates as high as 36.94 per 100 person-years. Thus, the stroke risk stratification scheme recommended in the ESC guidelines (based on the CHA2DS2-VASc score) would be best at identifying the "truly low risk" subjects with AF who do not need any antithrombotic therapy.

  20. State level correlations between high heart attack and stroke symptomology knowledge scores and CVD risk factors and mortality rates

    Directory of Open Access Journals (Sweden)

    Mary Nawal Lutfiyya

    2013-09-01

    Full Text Available Introduction: In 2008, cardiovascular disease (CVD accounted for one in three deaths in the United States. Epidemiological analyses suggest that two or more risk factors are the indicator of high risk and/or poor CVD outcomes. Knowledge of heart attack and stroke symptomology has been the focus of much research based on the assumption that accurate identification of an event is critical to reducing time to treatment. There is a paucity of research showing a clear association between knowledge of heart attack and stroke symptomology, risk factors, and mortality rates. In this study, we hypothesized that high stroke and heart attack symptomology knowledge scores would correspond to lower stroke or CVD mortality rankings as well as to a lower prevalence of two or more CVD risk factors. Methods: State was the unit of analysis used to examine data from two different sources and combined into a customized database. The first source was a multiyear Behavioral Risk Factor Surveillance Survey (BRFSS heart attack and stroke symptom knowledge module database. CVD and stroke mortality data used came from the American Heart Association’s (AHA 2012 Heart Disease and Stroke Statistics Update. Spearman’s Rho was the test statistic. Results: A moderate negative correlation was found between high heart attack and stroke symptom knowledge scores and the percentage of adults with two or more CVD or stroke risk factors. Likewise, a similar correlation resulted from the two variables, high heart attack and stroke symptoms knowledge score and CVD mortality rank. Conclusions: This study demonstrated a significant relationship between high heart attack and stroke symptom knowledge and lower CVD mortality rates and lower prevalence of two or more CVD risk factors at the state level. Our findings suggest that it is important to continue education efforts regarding heart attack and stroke symptom knowledge. Pharmacists are one group of health care providers who could enhance the needed public health education efforts.

  1. Consideration of QRS complex in addition to ST segment abnormalities in the estimation of the 'risk region' during acute inferior myocardial infarction

    DEFF Research Database (Denmark)

    van Hellemond, Irene E. G.; Bouwmeester, Sjoerd

    2013-01-01

    The myocardial area at risk (MaR) has been estimated in patients with acute myocardial infarction (AMI) by using ST segment based ECG methods. However, as the process from ischemia to infarction progresses, the ST segment deviation is typically replaced by QRS abnormalities, causing a falsely low estimation of the total MaR if determined by using ST segment based methods. A previous study showed the value of the consideration of the abnormalities in the QRS complex, in addition to those in the ST segment estimating the total MaR for patients with anterior AMI. The purpose of this study was to investigate the same method for patients with inferior AMI.

  2. Jurors report that risk measure scores matter in sexually violent predator trials, but that other factors matter more.

    Science.gov (United States)

    Turner, Darrel B; Boccaccini, Marcus T; Murrie, Daniel C; Harris, Paige B

    2015-02-01

    After deliberating to a verdict, jurors (N?=?462) from 40 sexually violent predator (SVP) trials completed a questionnaire asking them to rate the extent to which risk measure scores, diagnoses, expert witness testimony, and offender characteristics described during the trials influenced their commitment decisions. Jurors reported that offenders' sexual offending history, failure to change, and lack of remorse had the strongest influence on their commitment decisions. They reported that testimony about risk instrument scores (e.g., Static-99) and psychopathy had less influence on their decisions, but those who did report being influenced by instrument results were especially likely to view the offender as being at a high risk for reoffending. Overall, findings suggest that SVP jurors view risk measure results as important, but not as important as other offender, offense, and testimony characteristics, including some that have limited relevance to recidivism risk. Thus, findings also suggest that experts may need to better educate jurors regarding factors that do and do not relate to recidivism risk. PMID:25613035

  3. Does present use of cardiovascular medication reflect elevated cardiovascular risk scores estimated ten years ago? A population based longitudinal observational study

    Directory of Open Access Journals (Sweden)

    Straand Jørund

    2011-03-01

    Full Text Available Abstract Background It is desirable that those at highest risk of cardiovascular disease should have priority for preventive measures, eg. treatment with prescription drugs to modify their risk. We wanted to investigate to what extent present use of cardiovascular medication (CVM correlates with cardiovascular risk estimated by three different risk scores (Framingham, SCORE and NORRISK ten years ago. Methods Prospective logitudinal observational study of 20 252 participants in The Hordaland Health Study born 1950-57, not using CVM in 1997-99. Prescription data obtained from The Norwegian Prescription Database in 2008. Results 26% of men and 22% of women aged 51-58 years had started to use some CVM during the previous decade. As a group, persons using CVM scored significantly higher on the risk algorithms Framingham, SCORE and NORRISK compared to those not treated. 16-20% of men and 20-22% of women with risk scores below the high-risk thresholds for the three risk scores were treated with CVM, while 60-65% of men and 25-45% of women with scores above the high-risk thresholds received no treatment. Among women using CVM, only 2.2% (NORRISK, 4.4% (SCORE and 14.5% (Framingham had risk scores above the high-risk values. Low education, poor self-reported general health, muscular pains, mental distress (in females only and a family history of premature cardiovascular disease correlated with use of CVM. Elevated blood pressure was the single factor most strongly predictive of CVM treatment. Conclusion Prescription of CVM to middle-aged individuals by large seems to occur independently of estimated total cardiovascular risk, and this applies especially to females.

  4. Hypertension and the risk of acute myocardial infarction in Argentina. The Argentine Factores de Riesgo Coronario en America del Sur (FRICAS) Investigators.

    Science.gov (United States)

    Ciruzzi, M; Pramparo, P; Rozlosnik, J; Zylberstjn, H; Delmonte, H; Haquim, M; Abecasis, B; de La Cruz Ojeda, J; Mele, E; La Vecchia, C; Schargrodsky, H

    2001-01-01

    The relationship between a history of hypertension and the quality of its control in routine clinical practice and the risk of acute myocardial infarction was examined in a multicenter, case-control study conducted in Argentina between November 1991 and August 1994, within the framework of the FRICAS study. The cases were 939 patients with acute myocardial infarction and without a history of ischemic heart disease. The controls were 949 subjects identified in the same centers as the cases and admitted with a wide spectrum of acute disorders unrelated to known or suspected risk factors for acute myocardial infarction. The odds ratios and the 95% confidence intervals were derived from multiple logistic regression equations, including terms for age, gender, education, social status, exercise, smoking status, cholesterolemia, history of diabetes, body mass index, and family history of myocardial infarction. The quality of hypertension control was assessed with the most recent blood pressure reading reported by the subjects. Seventy-two percent of hypertensive cases and 62.6% of hypertensive controls had a history of antihypertensive therapy by self-report, when admitted to the medical center. The adjusted odds ratio for acute myocardial infarction due to hypertension was 2.58 (95% confidence interval, 2.08-3.19). The odds ratio was 2.42 (95% confidence interval, 1.88-3.11) when hypertensives reported that their greatest systolic value was below 200 mm Hg (moderate status) and 4.12 (95% confidence interval, 2.87-5.89) when it was above 200 mm Hg (severe status). When the highest diastolic blood pressure value was below 120 mm Hg (moderate status), the risk increased to 2.48 (95% confidence intervals, 1.90-3.24) and to 4.12 (95% confidence interval, 2.83-5.99) when it was above 120 mm Hg (severe status). If the most recent systolic blood pressure was less-than-or-equal140 mm Hg, the odds ratio was 2.59 (95% confidence interval, 1.96-3.41), and it was 3.42 (95% confidence interval, 2.40-4.87) when the value was >140 mm Hg. If the most recent diastolic blood pressure was less-than-or-equal90 mm Hg, the risk increased more than two fold (odds ratio=2.48; 95% confidence interval, 1.91-3.22), and if it was >90 mm Hg, it increased nearly four-fold (odds ratio=3.72; 95% confidence interval, 2.33-5.96). In smokers, the odds ratio was 2.28 in the absence of hypertension and increased to 7.51 when hypertension was present. In this Argentine population, hypertension is a strong and independent risk factor for acute myocardial infarction. In routine clinical practice, the control of blood pressure to levels below 140/90 seems to be required in order to reduce part (but not all) of the risk of acute myocardial infarction in hypertensive patients. (c) 2001 by CHF, Inc. PMID:11828201

  5. Follicular lymphoma patients with a high FLIPI score and a high tumor burden: A risk stratification model

    Directory of Open Access Journals (Sweden)

    An?eli? Boško

    2015-01-01

    Full Text Available Background/Aim. The widely accepted Follicular Lymphoma International Prognostic Index (FLIPI divides patients into three risk groups based on the score of adverse prognostic factors. The estimated 5-year survival in patients with a high FLIPI score is around 50%. The aim of this study was to analyse the prognostic value of clinical and laboratory parameters that are not included in the FLIPI and the New Prognostic Index for Follicular Lymphoma developed by the International Follicular Lymphoma Prognostic Factor Project (FLIPI2 indices, in follicular lymphoma (FL patients with a high FLIPI score and high tumor burden. Methods. The retrospective analysis included 57 newly diagnosed patients with FL, a high FLIPI score and a high tumor burden. All the patients were diagnosed and treated between April 2000 and June 2007 at the Clinic for Hematology, Clinical Center of Serbia, Belgrade. Results. The patients with a histological grade > 1, erythrocyte sedimentation rate (ESR ± 45 mm/h and hypoalbuminemia had a significantly worse overall survival (p = 0.015; p = 0.001; p = 0.008, respectively, while there was a tendency toward worse overall survival in the patients with an Eastern Cooperative Oncology Group (ECOG > 1 (p = 0.075. Multivariate Cox regression analysis identified a histological grade > 1, ESR ± 45 mm/h and hypoalbuminemia as independent risk factors for a poor outcome. Based on a cumulative score of unfavourable prognostic factors, patients who had 0 or 1 unfavourable factors had a significantly better 5-year overall survival compared to patients with 2 or 3 risk factors (75% vs 24.1%, p = 0.000. Conclusion. The obtained results suggest that from the examined prognostic parameters histological grade > 1, ESR ± 45 mm/h and hypoalbuminemia can contribute in defining patients who need more aggressive initial treatment approach, if two or three of these parameters are present on presentation.

  6. Risk stratification in trauma and haemorrhagic shock: Scoring systems derived from the TraumaRegister DGU(®).

    Science.gov (United States)

    Wutzler, Sebastian; Maegele, Marc; Wafaisade, Arasch; Wyen, Hendrik; Marzi, Ingo; Lefering, Rolf

    2014-10-01

    Scoring systems commonly attempt to reduce complex clinical situations into one-dimensional values by objectively valuing and combining a variety of clinical aspects. The aim is to allow for a comparison of selected patients or cohorts. To appreciate the true value of scoring systems in patients with multiple injuries it is necessary to understand the different purposes of quantifying the severity of specific injuries and overall trauma load, being: (1) clinical decision making; (2) triage; (3) planning of trauma systems and resources; (4) epidemiological and clinical research; (5) evaluation of outcome and trauma systems, including quality assessment; and (6) estimation of costs and allocation of resources. For the first two, easy-to estimate scores with immediate availability are necessary, mainly based on initial physiology. More sophisticated scores considering age, gender, injury pattern/severity and more are usually used for research and outcome evaluation, once the diagnostic and therapeutic process has been completed. For score development large numbers of data are necessary and thus, it appears as a logical consequence that large registries as the TraumaRegister DGU(®) of the German Trauma Society (TR-DGU) are used to derive and validate clinical scoring systems. A variety of scoring systems have been derived from this registry, the majority of them with focus on hospital mortality. The most important among these systems is probably the RISC score, which is currently used for quality assessment and outcome adjustment in the annual audit reports. This report summarizes the various scoring systems derived from the TraumaRegister DGU(®) over the recent years. PMID:25284230

  7. Automatic computation of CHA2DS2-VASc score: information extraction from clinical texts for thromboembolism risk assessment.

    Science.gov (United States)

    Grouin, Cyril; Deléger, Louise; Rosier, Arnaud; Temal, Lynda; Dameron, Olivier; Van Hille, Pascal; Burgun, Anita; Zweigenbaum, Pierre

    2011-01-01

    The CHA2DS2-VASc score is a 10-point scale which allows cardiologists to easily identify potential stroke risk for patients with non-valvular fibrillation. In this article, we present a system based on natural language processing (lexicon and linguistic modules), including negation and speculation handling, which extracts medical concepts from French clinical records and uses them as criteria to compute the CHA2DS2-VASc score. We evaluate this system by comparing its computed criteria with those obtained by human reading of the same clinical texts, and by assessing the impact of the observed differences on the resulting CHA2DS2-VASc scores. Given 21 patient records, 168 instances of criteria were computed, with an accuracy of 97.6%, and the accuracy of the 21 CHA2DS2-VASc scores was 85.7%. All differences in scores trigger the same alert, which means that system performance on this test set yields similar results to human reading of the texts. PMID:22195104

  8. Validation of a modified clinical risk score to predict cancer-specific survival for stage II colon cancer

    Science.gov (United States)

    Oliphant, Raymond; Horgan, Paul G; Morrison, David S; McMillan, Donald C

    2015-01-01

    Many patients with stage II colon cancer will die of their disease despite curative surgery. Therefore, identification of patients at high risk of poor outcome after surgery for stage II colon cancer is desirable. This study aims to validate a clinical risk score to predict cancer-specific survival in patients undergoing surgery for stage II colon cancer. Patients undergoing surgery for stage II colon cancer in 16 hospitals in the West of Scotland between 2001 and 2004 were identified from a prospectively maintained regional clinical audit database. Overall and cancer-specific survival rates up to 5 years were calculated. A total of 871 patients were included. At 5 years, cancer-specific survival was 81.9% and overall survival was 65.6%. On multivariate analysis, age ?75 years (hazard ratio (HR) 2.11, 95% confidence intervals (CI) 1.57–2.85; P<0.001) and emergency presentation (HR 1.97, 95% CI 1.43–2.70; P<0.001) were independently associated with cancer-specific survival. Age and mode of presentation HRs were added to form a clinical risk score of 0–2. The cancer-specific survival at 5 years for patients with a cumulative score 0 was 88.7%, 1 was 78.2% and 2 was 65.9%. These results validate a modified simple clinical risk score for patients undergoing surgery for stage II colon cancer. The combination of these two universally documented clinical factors provides a solid foundation for the examination of the impact of additional clinicopathological and treatment factors on overall and cancer-specific survival. PMID:25487740

  9. Using electronic health record data to develop inpatient mortality predictive model: Acute Laboratory Risk of Mortality Score (ALaRMS)

    OpenAIRE

    Tabak, Ying P; Sun, Xiaowu; Nunez, Carlos M; Johannes, Richard S.

    2014-01-01

    Objective: Using numeric laboratory data and administrative data from hospital electronic health record (EHR) systems, to develop an inpatient mortality predictive model. Methods: Using EHR data of 1 428 824 adult discharges from 70 hospitals in 2006–2007, we developed the Acute Laboratory Risk of Mortality Score (ALaRMS) using age, gender, and initial laboratory values on admission as candidate variables. We then added administrative variables using the Agency for Healthcare Research and Q...

  10. Risk prediction scores for recurrence and progression of non-muscle invasive bladder cancer : an international validation in primary tumours

    DEFF Research Database (Denmark)

    Vedder, Moniek M; Márquez, Mirari

    2014-01-01

    OBJECTIVE: We aimed to determine the validity of two risk scores for patients with non-muscle invasive bladder cancer in different European settings, in patients with primary tumours. METHODS: We included 1,892 patients with primary stage Ta or T1 non-muscle invasive bladder cancer who underwent a transurethral resection in Spain (n?=?973), the Netherlands (n?=?639), or Denmark (n?=?280). We evaluated recurrence-free survival and progression-free survival according to the European Organisation for Research and Treatment of Cancer (EORTC) and the Spanish Urological Club for Oncological Treatment (CUETO) risk scores for each patient and used the concordance index (c-index) to indicate discriminative ability. RESULTS: The 3 cohorts were comparable according to age and sex, but patients from Denmark had a larger proportion of patients with the high stage and grade at diagnosis (p<0.01). At least one recurrence occurred in 839 (44%) patients and 258 (14%) patients had a progression during a median follow-up of 74 months. Patients from Denmark had the highest 10-year recurrence and progression rates (75% and 24%, respectively), whereas patients from Spain had the lowest rates (34% and 10%, respectively). The EORTC and CUETO risk scores both predicted progression better than recurrence with c-indices ranging from 0.72 to 0.82 while for recurrence, those ranged from 0.55 to 0.61. CONCLUSION: The EORTC and CUETO risk scores can reasonably predict progression, while prediction of recurrence is more difficult. New prognostic markers are needed to better predict recurrence of tumours in primary non-muscle invasive bladder cancer patients.

  11. Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients

    DEFF Research Database (Denmark)

    Podlekareva, D N; Grint, D

    2013-01-01

    To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome.

  12. Fatores de risco para infarto do miocárdio no Brasil: estudo FRICAS / Risk factors for acute myocardial infarction in Brazil (FRICAS study)

    Scientific Electronic Library Online (English)

    Marco Aurélio Dias da, Silva; Amanda G. M. R., Sousa; Hernan, Schargodsky.

    1998-11-01

    Full Text Available OBJETIVO: Determinar os fatores de risco para a ocorrência de infarto agudo do miocárdio (IAM) no Brasil. MÉTODOS: Estudo conduzido entre janeiro/94 e março/95, em 20 centros médicos no Brasil, constituído de casos, 299 pacientes com IAM e, controles, 292 indivíduos, identificados no mesmo centro qu [...] e os casos, e admitidos com largo espectro de doenças agudas, não relacionadas a fatores de risco conhecidos ou suspeitos para IAM. Os dados foram colhidos por meio de um questionário estruturado, preenchido pelo próprio paciente. Os efeitos das variáveis pesquisadas sobre a ocorrência de IAM foram estudadas em abordagens univariadas, considerando-se significativo p Abstract in english PURPOSE: To determine risk factors related to acute myocardial infarction (AMI) in Brazil. METHODS: Five hundred ninety one patients were selected in 20 medical centers in Brazil, between January/94 and March/95. Two-hundred-ninety-nine patients were cases, and 292 controls with a variety of acute d [...] iseases not related to the suspected or known risk factors for acute myocardial infarction. All data were collected through a structured questionnaire filled by the patients. The evaluation of the variables was done through univariate analysis with a significance level of 5%. RESULTS: The factors related to acute myocardial infarction were respectively to cases and controls: Hypercholesterolemia - 210.93±46.74mg/dl and 185.71±45.45mg/dl, (p=0.000); smoking - 41.69% and 27.20% (p=0.000); hypertension - 52.35% and 20.88% (p=0.000); diabetes - 19.70% and 9.93% (p=0.001); family history - related to the patient's father in 42.14% and 33.22% (p=0.025) and to the mother in 42.14% and 30.82% (p=0.007); socioeconomic level - 88.99% and 60.20% owned house (p=0.002); 44.45% and 33.21% owned car (p=0.010); physical activity - 56.83% and 48.28% had the habit of walking in the year prior to study entry (p=0.029); diet - 38.79% and 28.42% consumed canned food (p=0.013). The mean weight was 72.50±26.89kg and 69±12.26kg (p=0.0271). The mean height was 166.56±8.81cm and 166.66±8.47cm. CONCLUSION: This study confirmed the importance of hypercholesterolemia, hypertension, diabetes mellitus, overweight and family history as risk factors for acute myocardial infarction. There was a significant relation between socioeconomic level and the prevalence of acute myocardial infarction.

  13. Risk of myocardial infarction and death associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals: a nationwide cohort study

    DEFF Research Database (Denmark)

    FosbØl, E L; Gislason, G H

    2009-01-01

    Use of some nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased cardiovascular risk in several patient groups, but whether this excess risk exists in apparently healthy individuals has not been clarified. Using a historical cohort design, we estimated the risk of death and myocardial infarction associated with the use of NSAIDs. Participants in the study were selected from the Danish population and were defined as healthy according to a history of no hospital admissions and no concomitant selected pharmacotherapy. The source population consisted of 4,614,807 individuals, of whom 1,028,437 were included in the study after applying selection criteria. Compared to no NSAID use, hazard ratios (95% confidence limits) for death/myocardial infarction were 1.01 (0.96-1.07) for ibuprofen, 1.63 (1.52-1.76) for diclofenac, 0.97 (0.83-1.12) for naproxen, 2.13 (1.89-2.41) for rofecoxib, and 2.01 (1.78-2.27) for celecoxib. A dose-dependent increase in cardiovascular risk was seen for selective COX-2 inhibitors and diclofenac. Caution should be exercised in NSAID use in all individuals, and particularly high doses should be avoided if possible.

  14. Clinical study on magnetic resonance imaging of lacunar infarcts and cerebrovascular high-risk group

    International Nuclear Information System (INIS)

    Magnetic resonance imaging (MRI) study was performed in 32 patients with recent lacunar stroke. T2-weighted images showed ischemic lesions more clearly than T1-weighted images. Sixty-six percent of 32 patients had periventricular lesions. Eighty-four percent had subcortical white matter lesions. Sixty-nine percent had lesions in basal ganglia. Twenty-eight percent had lesions in brainstem. Periventricular lesions were revealed symmetrically. On the other hand, lesions in other areas were not detected symmetrically. Severe periventricular lesions on MRI were similar to those of Binswanger's disease. Patients with severe periventricular lesions had often hypertension. Moreover, two of them had dementia. Twenty-three patients with transient ischemic attack had less remarkable lesions than patients with lacunar stroke. Thirty-seven patients with a history of cerebrovascular risk factors (hypertension, diabetes mellitus) had severer lesions compared with normal controls. Sixty-one percent of controls, who had no cerebrovascular symptoms and signs, had MRI lesions. These results suggest that MRI is useful for detection of cerebral ischemic lesions with no associated clinical symptoms or signs. (author)

  15. Duration of Treatment With Nonsteroidal Anti-Inflammatory Drugs and Impact on Risk of Death and Recurrent Myocardial Infarction in Patients With Prior Myocardial Infarction: A Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Olsen, Anne-Marie Schjerning; FosbØl, Emil L

    2011-01-01

    Background- Despite the fact that nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated among patients with established cardiovascular disease, many receive NSAID treatment for a short period of time. However, little is known about the association between NSAID treatment duration and risk of cardiovascular disease. We therefore studied the duration of NSAID treatment and cardiovascular risk in a nationwide cohort of patients with prior myocardial infarction (MI). Methods and Results- Patients ?30 years of age who were admitted with first-time MI during 1997 to 2006 and their subsequent NSAID use were identified by individual-level linkage of nationwide registries of hospitalization and drug dispensing from pharmacies in Denmark. Risk of death and recurrent MI according to duration of NSAID treatment was analyzed by multivariable time-stratified Cox proportional-hazard models and by incidence rates per 1000 person-years. Of the 83 677 patients included, 42.3% received NSAIDs during follow-up. Therewere 35 257 deaths/recurrent MIs. Overall, NSAID treatment was significantly associated with an increased risk of death/recurrent MI (hazard ratio, 1.45; 95% confidence interval, 1.29 to 1.62) at the beginning of the treatment, and the risk persisted throughout the treatment course (hazard ratio, 1.55; 95% confidence interval, 1.46 to 1.64 after 90 days). Analyses of individual NSAIDs showed that the traditional NSAID diclofenac was associated with the highest risk (hazard ratio, 3.26; 95% confidence interval, 2.57 to 3.86 for death/MI at day 1 to 7 of treatment). Conclusions- Even short-term treatment with most NSAIDs was associated with increased risk of death and recurrent MI in patients with prior MI. Neither short- nor long-term treatment with NSAIDs is advised in this population, and any NSAID use should be limited from a cardiovascular safety point of view.

  16. Edad avanzada y factores de riesgo para infarto agudo de miocardio Risk factors for acute myocardial infarction in the elderly

    Directory of Open Access Journals (Sweden)

    M. A. Ciruzzi

    2002-12-01

    Full Text Available Este estudio caso-control analizó en los sujetos añosos el rol de los factores de riesgo coronario en el desarrollo del infarto agudo de miocardio (IAM, estableció la naturaleza de esta asociación y el grado de riesgo. Los datos fueron obtenidos en una investigación que incluyó 1060 casos y 1071 controles, realizada en 35 unidades coronarias de centros médicos de Argentina entre noviembre de 1991 y agosto de 1994. Nuestro análisis se basó en la información de los sujetos mayores de 65 años. Los casos fueron 427 pacientes con un primer IAM. Los controles fueron 396 sujetos sin evidencias clinicas de enfermedad cardiovascular, seleccionados en los mismos centros que los casos. Los Odds Ratios (OR y su intervalo de confianza del 95% (IC 95% se obtuvieron mediante un análisis de regresión logística, incluyendo variables como la edad, educación, clase social, tabaquismo, antecedente de diabetes o hipertensión arterial, índice de masa corporal e historia familiar de enfermedad coronaria. Los factores de riesgo relacionados independientemente con IAM fueron los siguientes: hipercolesterolemia (colesterol sérico > 240 mg/dl: OR=1.76 (IC 95%: 1.25-2.49, tabaquismo: OR=1.6 (IC 95%: 1.06-2.4, hipertensión arterial: OR=2.05 (IC 95%: 1.51-2.73, diabetes OR=1.71 (IC 95%: 1.12-2.70, historia de un familiar con enfermedad coronaria: OR=1.36 (IC 95%: 0.93-1.97 y de dos o más familiares: OR=2.63 (IC 95%: 1.21-5.71. Este estudio, confirma en los sujetos de edad avanzada la importancia de la hipercolesterolemia, del tabaquismo, la hipertesión arterial, la diabetes y la historia familiar de enfermedad coronaria como factores de riesgo de IAMThis case-control study, analized the role of coronary risk factors in acute myocardial infarction (AMI in the elderly, and established the nature of this association and the degree of risk. Data were derived from an investigation (1060 cases and 1071 controls conducted in 35 coronary care units from clinical centres in Argentina between November 1991 and August 1994. Our analysis was based on data collected from subjets over age 65. Cases were 427 patients with AMI and without history of ischaemic heart disease. Controls were 396 subjects identified in the same centres as the cases. Odds ratios (OR estimates and their 95% confidence intervals (CI were derived from multiple logistic regression equations including terms for age, education, social status, smoking status, history of diabetes or hypertension, body mass index and family history of coronary heart disease. The risk factors independently and strongly related to the risk of AMI were the following: hyperlipidemia (serum cholesterol > 240 mg/dl: OR=1.76 (95% CI: 1.25-2.49, smoking habits: OR=1.6 (95% CI: 1.06-2.4, hypertension: OR=2.05 (95% CI: 1.51-2.73, diabetes OR=1.71 (95% CI: 1.12-2.70, one relative with family history of coronary heart disease: OR=1.36 (95% CI: 0.93-1.97 and two or more relatives: OR=2.63 (95% CI: 1.21-5.71. This study confirms in the elderly the importance of hyperlipidemia, tobacco, hypertension, diabetes and family history of coronary heart disease as risks factors of AMI.

  17. Edad avanzada y factores de riesgo para infarto agudo de miocardio / Risk factors for acute myocardial infarction in the elderly

    Scientific Electronic Library Online (English)

    M. A., Ciruzzi; H., Schargrozky; P., Pramparo; J., Rosloznyk; H., Zylberstejn; M., Haquim; V., Rudich; A., Caccavo; D., Pizkorz.

    2002-12-01

    Full Text Available Este estudio caso-control analizó en los sujetos añosos el rol de los factores de riesgo coronario en el desarrollo del infarto agudo de miocardio (IAM), estableció la naturaleza de esta asociación y el grado de riesgo. Los datos fueron obtenidos en una investigación que incluyó 1060 casos y 1071 co [...] ntroles, realizada en 35 unidades coronarias de centros médicos de Argentina entre noviembre de 1991 y agosto de 1994. Nuestro análisis se basó en la información de los sujetos mayores de 65 años. Los casos fueron 427 pacientes con un primer IAM. Los controles fueron 396 sujetos sin evidencias clinicas de enfermedad cardiovascular, seleccionados en los mismos centros que los casos. Los Odds Ratios (OR) y su intervalo de confianza del 95% (IC 95%) se obtuvieron mediante un análisis de regresión logística, incluyendo variables como la edad, educación, clase social, tabaquismo, antecedente de diabetes o hipertensión arterial, índice de masa corporal e historia familiar de enfermedad coronaria. Los factores de riesgo relacionados independientemente con IAM fueron los siguientes: hipercolesterolemia (colesterol sérico > 240 mg/dl): OR=1.76 (IC 95%: 1.25-2.49), tabaquismo: OR=1.6 (IC 95%: 1.06-2.4), hipertensión arterial: OR=2.05 (IC 95%: 1.51-2.73), diabetes OR=1.71 (IC 95%: 1.12-2.70), historia de un familiar con enfermedad coronaria: OR=1.36 (IC 95%: 0.93-1.97) y de dos o más familiares: OR=2.63 (IC 95%: 1.21-5.71). Este estudio, confirma en los sujetos de edad avanzada la importancia de la hipercolesterolemia, del tabaquismo, la hipertesión arterial, la diabetes y la historia familiar de enfermedad coronaria como factores de riesgo de IAM Abstract in english This case-control study, analized the role of coronary risk factors in acute myocardial infarction (AMI) in the elderly, and established the nature of this association and the degree of risk. Data were derived from an investigation (1060 cases and 1071 controls) conducted in 35 coronary care units f [...] rom clinical centres in Argentina between November 1991 and August 1994. Our analysis was based on data collected from subjets over age 65. Cases were 427 patients with AMI and without history of ischaemic heart disease. Controls were 396 subjects identified in the same centres as the cases. Odds ratios (OR) estimates and their 95% confidence intervals (CI) were derived from multiple logistic regression equations including terms for age, education, social status, smoking status, history of diabetes or hypertension, body mass index and family history of coronary heart disease. The risk factors independently and strongly related to the risk of AMI were the following: hyperlipidemia (serum cholesterol > 240 mg/dl): OR=1.76 (95% CI: 1.25-2.49), smoking habits: OR=1.6 (95% CI: 1.06-2.4), hypertension: OR=2.05 (95% CI: 1.51-2.73), diabetes OR=1.71 (95% CI: 1.12-2.70), one relative with family history of coronary heart disease: OR=1.36 (95% CI: 0.93-1.97) and two or more relatives: OR=2.63 (95% CI: 1.21-5.71). This study confirms in the elderly the importance of hyperlipidemia, tobacco, hypertension, diabetes and family history of coronary heart disease as risks factors of AMI.

  18. Development and validation of a bedside risk score for MRSA among patients hospitalized with complicated skin and skin structure infections

    Directory of Open Access Journals (Sweden)

    Zilberberg Marya D

    2012-07-01

    Full Text Available Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA is a frequent cause of complicated skin and skin structure infections (cSSSI. Patients with MRSA require different empiric treatment than those with non-MRSA infections, yet no accurate tools exist to aid in stratifying the risk for a MRSA cSSSI. We sought to develop a simple bedside decision rule to tailor empiric coverage more accurately. Methods We conducted a large multicenter (N=62 hospitals retrospective cohort study in a US-based database between April 2005 and March 2009. All adult initial admissions with ICD-9-CM codes specific to cSSSI were included. Patients admitted with MRSA vs. non-MRSA were compared with regard to baseline demographic, clinical and hospital characteristics. We developed and validated a model to predict the risk of MRSA, and compared its performance via sensitivity, specificity and other classification statistics to the healthcare-associated (HCA infection risk factors. Results Of the 7,183 patients with cSSSI, 2,387 (33.2% had MRSA. Factors discriminating MRSA from non-MRSA were age, African-American race, no evidence of diabetes mellitus, cancer or renal dysfunction, and prior history of cardiac dysrhythmia. The score ranging from 0 to 8 points exhibited a consistent dose–response relationship. A MRSA score of 5 or higher was superior to the HCA classification in all characteristics, while that of 4 or higher was superior on all metrics except specificity. Conclusions MRSA is present in 1/3 of all hospitalized cSSSI. A simple bedside risk score can help discriminate the risk for MRSA vs. other pathogens with improved accuracy compared to the HCA definition.

  19. Towards an Evidence Based Score Card for Aligning Risk Management and Sustainability Goals for Essential NORM Industries: Case Study - Phosphates

    International Nuclear Information System (INIS)

    Approaches to regulating NORM industries risk suffering blight from over-conservative methodologies, whether based on worst case models, extreme event scenarios or unmediated application of the precautionary principle: the outcome can be a significant overestimation of risk and a consequent penalty on both producers and consumers in terms of access to and affordability of the intermediate and end products those industries provide. In particular, for historical reasons derived perhaps from the potentially distracting regulatory focus on what is usually trace radioactivity in products and by-products containing NORM, there is a damaging tendency to seek risk management models and best practices from nuclear industries in general rather than from those sectors to which the end products of NORM industries are specifically aligned. This risk is particularly visible in the phosphate sector, an industry now pivotal to long term security and sustainability in both food production and energy supply, plant based or nuclear. Premised on a companion paper which sets out the theory of 'constructive regulation', presented in 2008 at the 12th International Congress of the International Radiation Protection Association, Buenos Aires, this paper proposes the use of an evidence based score carding system to ensure the future alignment of risk management and sustainability goals for NORM industries, starting with phosphates. The score card elements are broken out into three primary catents are broken out into three primary categories along the lines defined in the concept of triple bottom line performance measurement, comprising economic, social and environmental elements. The question is put as to what role constructive regulation and best practices can play in ensuring that the outcome of the regulatory process is the preservation and enhancement of the capability of these industries to deliver sustainable returns to the customers and stakeholders who depend on them. Score carding will facilitate transparent, objective decision making and effective performance monitoring in both the short and long term, as measured against triple bottom line expectations. (author)

  20. Risk-based priority scoring for Brookhaven National Laboratory environmental restoration programs

    International Nuclear Information System (INIS)

    This report describes the process of estimating the risk associated with environmental restoration programs under the Brookhaven National Laboratory Office of Environmental Restoration. The process was part of an effort across all Department of Energy facilities to provide a consistent framework to communicate risk information about the facilities to senior managers in the DOE Office of Environmental Management to foster understanding of risk activities across programs. the risk evaluation was a qualitative exercise. Categories considered included: Public health and safety; site personnel safety and health; compliance; mission impact; cost-effective risk management; environmental protection; inherent worker risk; environmental effects of clean-up; and social, cultural, political, and economic impacts

  1. A multiparametric clinical and echocardiographic score to risk stratify patients with chronic systolic heart failure: derivation and testing.

    Science.gov (United States)

    Fontanive, Paolo; Miccoli, Mario; Simioniuc, Anca; Angelillis, Marco; Di Bello, Vitantonio; Baggiani, Angelo; Bongiorni, Maria Grazia; Marzilli, Mario; Dini, Frank Lloyd

    2013-11-01

    Although echo Doppler and biomarkers are the most common examinations performed worldwide in heart failure (HF), they are rarely considered in risk scores. In outpatients with chronic HF and left ventricular ejection fraction (LVEF) ?45%, data on clinical status, echo Doppler variables, aminoterminal pro-type B natriuretic peptide (NT-proBNP), estimated glomerular filtration rate (eGFR), and drug therapies were combined to build up a multiparametric score. We randomly selected 250 patients to produce a derivation cohort and 388 patients were used as a testing cohort. Follow-up lasted 29 ± 23 months. The univariable predictors that entered into the multivariable Cox model were as follows: furosemide daily dose >25 mg, inability to tolerate angiotensin converting enzyme (ACE) inhibitors, inability to tolerate ?-blockers, age >75 years, New York Heart Association (NYHA) >2, eGFR96 mL/m(2) , moderate-to-severe mitral regurgitation (MR) and LVEF <30%. The scores of prognostic factors were obtained with the respective odds ratio divided by the lower odd ratio: 4 points for furosemide dose, 3 points for age, NT-proBNP, LVEDVi, TAPSE, 2 points for inability to tolerate ?-blockers, inability to tolerate ACE inhibitors, NYHA, eGFR<60 mL/min, moderate-to-severe MR, 1 point for LVEF. The multiparametric score predicted all-cause mortality either in the derivation cohort (68.4% sensitivity, 79.5% specificity, area under the curve [AUC] 78.7%) or in the testing cohort (73.7% sensitivity, 71.3% specificity, AUC 77.2%). All-cause mortality significantly increased with increasing score both in the derivation and in the testing cohort (P < 0.0001). In conclusion, this multiparametric score is able to predict mortality in chronic systolic HF. PMID:23742144

  2. The Clinical Performance of an Office-Based Risk Scoring System for Fatal Cardiovascular Diseases in North-East of Iran

    Science.gov (United States)

    Sepanlou, Sadaf G.; Malekzadeh, Reza; Poustchi, Hossein; Sharafkhah, Maryam; Ghodsi, Saeed; Malekzadeh, Fatemeh; Etemadi, Arash; Pourshams, Akram; Pharoah, Paul D.; Abnet, Christian C.; Brennan, Paul; Boffetta, Paolo; Dawsey, Sanford M.; Kamangar, Farin

    2015-01-01

    Background Cardiovascular diseases (CVD) are becoming major causes of death in developing countries. Risk scoring systems for CVD are needed to prioritize allocation of limited resources. Most of these risk score algorithms have been based on a long array of risk factors including blood markers of lipids. However, risk scoring systems that solely use office-based data, not including laboratory markers, may be advantageous. In the current analysis, we validated the office-based Framingham risk scoring system in Iran. Methods The study used data from the Golestan Cohort in North-East of Iran. The following risk factors were used in the development of the risk scoring method: sex, age, body mass index, systolic blood pressure, hypertension treatment, current smoking, and diabetes. Cardiovascular risk functions for prediction of 10-year risk of fatal CVDs were developed. Results A total of 46,674 participants free of CVD at baseline were included. Predictive value of estimated risks was examined. The resulting Area Under the ROC Curve (AUC) was 0.774 (95% CI: 0.762-0.787) in all participants, 0.772 (95% CI: 0.753-0.791) in women, and 0.763 (95% CI: 0.747-0.779) in men. AUC was higher in urban areas (0.790, 95% CI: 0.766-0.815). The predicted and observed risks of fatal CVD were similar in women. However, in men, predicted probabilities were higher than observed. Conclusion The AUC in the current study is comparable to results of previous studies while lipid profile was replaced by body mass index to develop an office-based scoring system. This scoring algorithm is capable of discriminating individuals at high risk versus low risk of fatal CVD. PMID:26011607

  3. A novel risk score to predict cardiovascular disease risk in national populations (Globorisk) : a pooled analysis of prospective cohorts and health examination surveys

    DEFF Research Database (Denmark)

    Hajifathalian, Kaveh; Ueda, Peter

    2015-01-01

    BACKGROUND: Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be recalibrated and updated for application in different countries with routinely available information. METHODS: We used data from eight prospective cohort studies to estimate coefficients of the risk equation with proportional hazard regressions. The risk prediction equation included smoking, blood pressure, diabetes, and total cholesterol, and allowed the effects of sex and age on cardiovascular disease to vary between cohorts or countries. We developed risk equations for fatal cardiovascular disease and for fatal plus non-fatal cardiovascular disease. We validated the risk equations internally and also using data from three cohorts that were not used to create the equations. We then used the risk prediction equation anddata from recent (2006 or later) national health surveys to estimate the proportion of the population at different levels of cardiovascular disease risk in 11 countries from different world regions (China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and USA). FINDINGS: The risk score discriminated well in internal and external validations, with C statistics generally 70% or more. At any age and risk factor level, the estimated 10 year fatal cardiovascular disease risk varied substantially between countries. The prevalence of people at high risk of fatal cardiovascular disease was lowest in South Korea, Spain, and Denmark, where only 5-10% of men and women had more than a 10% risk, and 62-77% of men and 79-82% of women had less than a 3% risk. Conversely, the proportion of people at high risk of fatal cardiovascular disease was largest in China and Mexico. In China, 33% of men and 28% of women had a 10-year risk of fatal cardiovascular disease of 10% or more, whereas inMexico, the prevalence of this high risk was 16% for men and 11% for women. The prevalence of less than a 3% risk was 37% for men and 42% for women in China, and 55% for men and 69% for women in Mexico. INTERPRETATION: We developed a cardiovascular disease risk equation that can be recalibrated for application in different countries with routinely available information. The estimated percentage of people at high risk of fatal cardiovascular disease was higher in low-income and middle-income countries than in high-income countries. FUNDING: US National Institutes of Health, UK Medical Research Council, Wellcome Trust.

  4. Effects of PCSK9 genetic variants on plasma LDL cholesterol levels and risk of premature myocardial infarction in the Italian population

    OpenAIRE

    Guella, Ilaria; ASSELTA, ROSANNA; Ardissino, Diego; Merlini, Pier Angelica; Peyvandi, Flora; Kathiresan, Sekar; MANNUCCI, PIER MANNUCCIO; Tubaro, Marco; Duga, Stefano

    2010-01-01

    The R46L variant in the proprotein-convertase subtilisin-kexin type 9 (PCSK9) gene was associated with reduced levels of LDL and total cholesterol and with a lower risk of coronary artery disease. We investigated the association of R46L with myocardial infarction (MI) in 1,880 Italian patients with premature MI and 1,880 controls. A trend toward a protective effect of the L46 allele was observed [odds ratio (OR) = 0.75, 95% confidence interval (CI) = 0.49–1.13; P = 0.17], although the associa...

  5. Cardioprotective medication use and risk factor control among US adults with unrecognized myocardial infarction: the REasons for Geographic And Racial Differences in Stroke (REGARDS study

    Directory of Open Access Journals (Sweden)

    Levitan EB

    2013-02-01

    Full Text Available Emily B Levitan,1 Christopher Gamboa,1 Monika M Safford,2 Dana V Rizk,3 Todd M Brown,4 Elsayed Z Soliman,5 Paul Muntner11Department of Epidemiology, 2Division of Preventive Medicine, 3Division of Nephrology, 4Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA; 5Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston Salem, NC, USABackground: Individuals with unrecognized myocardial infarction (UMI have similar risks for cardiovascular events and mortality as those with recognized myocardial infarction (RMI. The prevalence of cardioprotective medication use and blood pressure and low-density lipoprotein cholesterol control among individuals with UMI is unknown.Methods: Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS study who were recruited between May 2004 and October 2007 received baseline twelve-lead electrocardiograms (n = 21,036. Myocardial infarction (MI status was characterized as no MI, UMI (electrocardiogram abnormalities consistent with MI without self-reported history; n = 949; 4.5%, and RMI (self-reported history of MI; n = 1574; 7.5%.Results: For participants with no MI, UMI, and RMI, prevalence of use was 38.4%, 44.4%, and 75.7% for aspirin; 18.0%, 25.8%, and 57.2% for beta blockers; 31.7%, 38.7%, and 55.0% for angiotensin converting enzyme inhibitors or angiotensin receptor blockers; and 28.1%, 33.9%, and 64.1% for statins, respectively. Participants with RMI were 35% more likely to have low-density lipoprotein cholesterol < 100 mg/dL than participants with UMI (prevalence ratio = 1.35, 95% confidence interval 1.19–1.52. Blood pressure control (<140/90 mmHg was similar between RMI and UMI groups (prevalence ratio = 1.03, 95% confidence interval 0.93–1.13.Conclusion: Although participants with UMI were somewhat more likely to use cardioprotective medications than those with no MI, they were less likely to use cardioprotective medications and to have controlled low-density lipoprotein cholesterol than participants with RMI. Increasing appropriate treatment and risk factor control among individuals with UMI may reduce risk of mortality and future cardiovascular events.Keywords: unrecognized myocardial infarction, secondary prevention, risk factor control

  6. Factores de riesgo coronarios asociados al infarto agudo del miocardio en el adulto mayor Coronary risk factors associated with the acute myocardial infarction in the elderly

    Directory of Open Access Journals (Sweden)

    Julia Tamara Alvarez Cortés

    2013-01-01

    Full Text Available Se realizó un estudio observacional, analítico y retrospectivo, de tipo caso-control, de los adultos mayores con infarto agudo del miocardio, pertenecientes al área de salud Municipal de Santiago de Cuba, desde enero de 2006 hasta diciembre de 2011, a fin de identificar los factores de riesgo coronarios asociados al mismo. Se seleccionaron 33 casos y 2 controles por cada uno de ellos. Se calcularon el riesgo relativo a través de la razón de productos cruzados y el riesgo atribuible en expuestos porcentual como medida de impacto. El sedentarismo y la hipertensión arterial tuvieron una acentuada relación significativa de causalidad con el infarto agudo del miocardio y de forma moderada con el tabaquismo, no así los antecedentes familiares ni personales de cardiopatía isquémica, sexo, obesidad y diabetes mellitus.An observational, analytic and retrospective study of case-control type, of aged patients with acute myocardial infarction, belonging to the health Municipal area of Santiago de Cuba was carried out from January, 2006 to December, 2011, in order to identify the coronary risk factors associated with it. Thirty three cases and two controls for each were selected. The relative risk through the odds ratio and the attributable risk in percentage exposed as impact measure were calculated. Sedentarism and hypertension had a considerable significant causative relationship with acute myocardial infarction and in a moderate way with smoking habit. Family or personal history of ischemic cardiopathy, sex, obesity or diabetes mellitus had no relation with it.

  7. Factores de riesgo coronarios asociados al infarto agudo del miocardio en el adulto mayor / Coronary risk factors associated with the acute myocardial infarction in the elderly

    Scientific Electronic Library Online (English)

    Julia Tamara, Alvarez Cortés; Vivian, Bello Hernández; Gipsy de los Ángeles, Pérez Hechavarría; Orlando, Antomarchi Duany; María Emilia, Bolívar Carrión.

    2013-01-01

    Full Text Available Se realizó un estudio observacional, analítico y retrospectivo, de tipo caso-control, de los adultos mayores con infarto agudo del miocardio, pertenecientes al área de salud Municipal de Santiago de Cuba, desde enero de 2006 hasta diciembre de 2011, a fin de identificar los factores de riesgo corona [...] rios asociados al mismo. Se seleccionaron 33 casos y 2 controles por cada uno de ellos. Se calcularon el riesgo relativo a través de la razón de productos cruzados y el riesgo atribuible en expuestos porcentual como medida de impacto. El sedentarismo y la hipertensión arterial tuvieron una acentuada relación significativa de causalidad con el infarto agudo del miocardio y de forma moderada con el tabaquismo, no así los antecedentes familiares ni personales de cardiopatía isquémica, sexo, obesidad y diabetes mellitus. Abstract in english An observational, analytic and retrospective study of case-control type, of aged patients with acute myocardial infarction, belonging to the health Municipal area of Santiago de Cuba was carried out from January, 2006 to December, 2011, in order to identify the coronary risk factors associated with [...] it. Thirty three cases and two controls for each were selected. The relative risk through the odds ratio and the attributable risk in percentage exposed as impact measure were calculated. Sedentarism and hypertension had a considerable significant causative relationship with acute myocardial infarction and in a moderate way with smoking habit. Family or personal history of ischemic cardiopathy, sex, obesity or diabetes mellitus had no relation with it.

  8. Replacement tunnelled dialysis catheters for haemodialysis access: Same site, new site, or exchange — A multivariate analysis and risk score

    International Nuclear Information System (INIS)

    Aim: To identify variables related to complications following tunnelled dialysis catheter (TDC) replacement and stratifying the risk to reduce morbidity in patients with end-stage renal disease. Materials and methods: One hundred and forty TDCs (Split Cath, medCOMP) were replaced in 140 patients over a 5 year period. Multiple variables were retrospectively collected and analysed to stratify the risk and to predict patients who were more likely to suffer from complications. Multivariate regression analysis was used to identify variables predictive of complications. Results: There were six immediate complications, 42 early complications, and 37 late complications. Multivariate analysis revealed that variables significantly associated to complications were: female sex (p = 0.003; OR 2.9); previous TDC in the same anatomical position in the past (p = 0.014; OR 4.1); catheter exchange (p = 0.038; OR 3.8); haemoglobin 15 s (p = 0.002; OR 4.1); and C-reactive protein >50 mg/l (p = 0.007; OR 4.6). A high-risk score, which used the values from the multivariate analysis, predicted 100% of the immediate complications, 95% of the early complications, and 68% of the late complications. Conclusion: Patients can now be scored prior to TDC replacement. A patient with a high-risk score can be optimized to reduce the chance of complications. Further prospective studies to confirm that rotating the site studies to confirm that rotating the site of TDC reduces complications are warranted as this has implications for current guidelines.

  9. Update of the German Diabetes Risk Score and external validation in the German MONICA/KORA study

    DEFF Research Database (Denmark)

    Mühlenbruch, Kristin; Ludwig, Tonia

    2014-01-01

    AIMS: Several published diabetes prediction models include information about family history of diabetes. The aim of this study was to extend the previously developed German Diabetes Risk Score (GDRS) with family history of diabetes and to validate the updated GDRS in the Multinational MONItoring of trends and determinants in CArdiovascular Diseases (MONICA)/German Cooperative Health Research in the Region of Augsburg (KORA) study. METHODS: We used data from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study for extending the GDRS, including 21,846 participants. Within 5 years of follow-up 492 participants developed diabetes. The definition of family history included information about the father, the mother and/or sibling/s. Model extension was evaluated by discrimination and reclassification. We updated the calculation of the score and absolute risks. External validation was performed in the MONICA/KORA study comprising 11,940 participants with 315 incident cases after 5 years of follow-up. RESULTS: The basic ROC-AUC of 0.856 (95%-CI: 0.842-0.870) was improved by 0.007 (0.003-0.011) when parent and sibling history was included in the GDRS. The net reclassification improvement was 0.110 (0.072-0.149), respectively. For the updated score we demonstrated good calibration across all tenths of risk. In MONICA/KORA, the ROC-AUC was 0.837 (0.819-0.855); regarding calibration we saw slight overestimation of absolute risks. CONCLUSIONS: Inclusion of the number of diabetes-affected parents and sibling history improved the prediction of type 2 diabetes. Therefore, we updated the GDRS algorithm accordingly. Validation in another German cohort study showed good discrimination and acceptable calibration for the vast majority of individuals.

  10. Comparison of Accuracy of Diabetes Risk Score and Components of the Metabolic Syndrome in Assessing Risk of Incident Type 2 Diabetes in Inter99 Cohort

    DEFF Research Database (Denmark)

    Shafizadeh, Tracy B; Moler, Edward J

    2011-01-01

    Background: Given the increasing worldwide incidence of diabetes, methods to assess diabetes risk which would identify those at highest risk are needed. We compared two risk-stratification approaches for incident type 2 diabetes mellitus (T2DM); factors of metabolic syndrome (MetS) and a previously developed diabetes risk score, PreDxH Diabetes Risk Score (DRS). DRS assesses 5 yr risk of incident T2DM based on the measurement of 7 biomarkers in fasting blood. Methodology/Principal Findings: DRS was evaluated in baseline serum samples from 4,128 non-diabetic subjects in the Inter99 cohort (Danes aged 30–60) for whom diabetes outcomes at 5 years were known. Subjects were classified as having MetS based on the presence of at least 3 MetS risk factors in baseline clinical data. The sensitivity and false positive rate for predicting diabetes using MetS was compared to DRS. When the sensitivity was fixed to match MetS, DRS had a significantly lower false positive rate. Similarly, when the false positive rate was fixed to match MetS, DRS had a significantly higher specificity. In further analyses, subjects were classified by presence of 0–2, 3 or 4–5 risk factors with matching proportions of subjects distributed among three DRS groups. Comparison between the two risk stratification schemes, MetS risk factors and DRS, were evaluated using Net Reclassification Improvement (NRI). Comparing risk stratification by DRS to MetS factors in the total population, the NRI was 0.146 (p = 0.008) demonstrating DRS provides significantly improved stratification. Additionally, the relative risk of T2DM differed by 15 fold between the low and high DRS risk groups, but only 8-fold between the low and high risk MetS groups. Conclusions/Significance: DRS provides a more accurate assessment of risk for diabetes than MetS. This improved performance may allow clinicians to focus preventive strategies on those most in need of urgent intervention.

  11. Genetic predisposition to coronary heart disease and stroke using an additive genetic risk score: a population-based study in Greece

    Science.gov (United States)

    Objective: To determine the extent to which the risk for incident coronary heart disease (CHD) increases in relation to a genetic risk score (GRS) that additively integrates the influence of high-risk alleles in nine documented single nucleotide polymorphisms (SNPs) for CHD, and to examine whether t...

  12. Value and limitations of existing scores for the assessment of cardiovascular risk: a review for clinicians.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2009-09-29

    Atherosclerotic cardiovascular diseases (CVDs) are the biggest causes of death worldwide. In most people, CVD is the product of a number of causal risk factors. Several seemingly modest risk factors may, in combination, result in a much higher risk than an impressively raised single factor. For this reason, risk estimation systems have been developed to assist clinicians to assess the effects of risk factor combinations in planning management strategies. In this article, the performances of the major risk estimation systems are reviewed. Most perform usably well in populations that are similar to the one used to derive the system, and in other populations if calibrated to allow for different CVD mortality rates and different risk factor distributions. The effect of adding "new" risk factors to age, sex, smoking, lipid status, and blood pressure is usually small, but may help to appropriately reclassify some of those patients who are close to a treatment threshold to a more correct "treat\\/do not treat" category. Risk estimation in the young and old needs more research. Quantification of the hoped-for benefits of the multiple risk estimation approach in terms of improved outcomes is still needed. But, it is likely that the widespread use of such an approach will help to address the issues of both undertreatment and overtreatment.

  13. Addition of brain and carotid imaging to the ABCD² score to identify patients at early risk of stroke after transient ischaemic attack: a multicentre observational study.

    OpenAIRE

    Merwick, A.; Albers, GW; Amarenco, P; Arsava, EM; Ay, H; Calvet, D.; Coutts, SB; Cucchiara, BL; Demchuk, AM; Furie, KL; Giles, MF; Labreuche, J; Lavallée, PC; Mas, JL; Olivot, JM

    2010-01-01

    BACKGROUND: The ABCD² score improves stratification of patients with transient ischaemic attack by early stroke risk. We aimed to develop two new versions of the score: one that was based on preclinical information and one that was based on imaging and other secondary care assessments. METHODS: We analysed pooled data from patients with clinically defined transient ischaemic attack who were investigated while in secondary care. Items that contribute to the ABCD² score (age, blood pressure, cl...

  14. Short communication: prevalence, risk factors, and a field scoring system for udder cleft dermatitis in Dutch dairy herds.

    Science.gov (United States)

    Olde Riekerink, R G M; van Amersfort, K; Sampimon, O C; Hooijer, G A; Lam, T J G M

    2014-08-01

    Udder cleft dermatitis (UCD) is a well-known disorder in dairy cows. Veterinary literature about this subject, however, is scarce. The objectives of this study were to define a clinical scoring system for UCD, estimate the within-herd prevalence of UCD, and identify potential risk factors of UCD at cow and herd level. On 20 randomly selected dairy farms in the Netherlands, each lactating cow was photographed from a ventral, lateral, and caudal position. A scoring system with 6 categories of severity of UCD was proposed based on the ventral photographs. Cow measures such as udder width and depth, and front quarter attachment were determined from the lateral and caudal photographs. A questionnaire was conducted on each farm during farm visits. Udder cleft dermatitis, defined as a score 3 or higher, was detected in 5.2% of the 948 cows involved in this study. Within-herd prevalences of UCD ranged between 0 and 15% and UCD was found in 16 (80%) of the participating farms. Cows with a deep udder (relative to the hock), large front quarters, and a small angle between udder and abdominal wall were more likely to develop UCD. Production level and use of a footbath were identified as being positively associated with herd-level UCD prevalence. Herd size and average bulk milk somatic cell count did not seem to be associated with UCD prevalence. Because of the small herd sample size, no firm conclusions were drawn on herd-level risk factors. However, results from this study can be used in designing a future longitudinal UCD study. The prevalences of UCD found in the present study illustrate the current UCD situation in the Netherlands. Our results demonstrate that multiple potential risk factors of UCD could be identified at both the cow and herd level. PMID:24856987

  15. Use of the All Patient Refined-Diagnosis Related Group (APR-DRG) Risk of Mortality Score as a Severity Adjustor in the Medical ICU

    OpenAIRE

    Syed Ali Riaz; Paul Richman; Erin Healy; Chen, John J.; Guangxiang Zhang; Ruel Garcia; Feroza Daroowalla; Daniel Baram

    2008-01-01

    Objective: To evaluate the performance of APR-DRG (All Patient Refined—Diagnosis Related Group) Risk of Mortality (ROM) score as a mortality risk adjustor in the intensive care unit (ICU).Design: Retrospective analysis of hospital mortality.Setting: Medical ICU in a university hospital located in metropolitan New York.Patients: 1213 patients admitted between February 2004 and March 2006.Main results: Mortality rate correlated significantly with increasing APR-DRG ROM scores (p 0.0001). Mul...

  16. Validação prospectiva do escore de risco dante pazzanese em síndrome coronariana aguda sem supradesnivelamento do segmento ST / Prospective validation of the dante pazzanese risk score in non-ST-segment elevation acute coronary syndrome

    Scientific Electronic Library Online (English)

    Elizabete Silva dos, Santos; Luiz, Minuzzo; Roberta de, Souza; Ari, Timerman.

    2013-09-01

    Full Text Available FUNDAMENTO: Em Síndrome Coronariana Aguda (SCA) sem Supradesnivelamento do segmento ST (SST) é importante estimar a probabilidade de eventos adversos. Para esse fim, as diretrizes recomendam modelos de estratificação de risco. O escore de risco Dante Pazzanese (escore DANTE) é um modelo simples de e [...] stratificação de risco, composto das variáveis: aumento da idade (0 a 9 pontos); antecedente de diabete melito (2 pontos) ou acidente vascular encefálico (4 pontos); não uso de inibidor da enzima conversora da angiotensina (1 ponto); elevação da creatinina (0 a 10 pontos); combinação de elevação da troponina e depressão do segmento ST (0 a 4 pontos). OBJETIVO: Validar o escore DANTE em pacientes com SCA sem SST. MÉTODOS: Estudo prospectivo, observacional, com inclusão de 457 pacientes, de setembro de 2009 a outubro de 2010. Os pacientes foram agrupados em: muito baixo, baixo, intermediário e alto risco de acordo com a pontuação do modelo original. A habilidade preditiva do escore foi avaliada pela estatística-C. RESULTADOS: Foram 291 (63,7%) homens e a média da idade 62,1 anos (11,04). Dezessete pacientes (3,7%) apresentaram o evento de morte ou (re)infarto em 30 dias. Ocorreu aumento progressivo na proporção do evento, com aumento da pontuação: muito baixo risco = 0,0%; baixo risco = 3,9%; risco intermediário = 10,9%; alto risco = 60,0%; p Abstract in english BACKGROUND: In non-ST-segment elevation acute coronary syndrome (ACS), the likelihood of adverse events should be estimated. Guidelines recommend risk stratification models for that purpose. The Dante Pazzanese risk score (DANTE score) is a simple risk stratification model composed with the followin [...] g variables: age increase (0 to 9 points); history of diabetes mellitus (2 points) or stroke (4 points); no use of angiotensin-converting-enzyme inhibitor (1 point); creatinine elevation (0 to 10 points); combination of troponin elevation and ST-segment depression (0 to 4 points). OBJECTIVE: To validate the DANTE score in patients with non-ST-segment elevation ACS. METHODS: Prospective, observational study including 457 patients, from September 2009 to October 2010. The patients were grouped in risk categories according to the original model score as follows: very low; low; intermediate; and high. The predictive ability of the score was assessed by using C-statistics. RESULTS: The sample comprised 291 (63.7%) men, the mean age being 62.1 years (SD=11.04). The event death or (re)infarction in 30 days was observed in 17 patients (3.7%). Progressive increase in the proportion of events was observed as the score increased: very low risk = 0.0%; low risk = 3.9%; intermediate risk = 10.9%; high risk = 60.0%; p

  17. Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

    Science.gov (United States)

    Mocroft, Amanda; Lundgren, Jens D.; Ross, Michael; Law, Matthew; Reiss, Peter; Kirk, Ole; Smith, Colette; Wentworth, Deborah; Neuhaus, Jacqueline; Fux, Christoph A.; Moranne, Olivier; Morlat, Phillipe; Johnson, Margaret A.; Ryom, Lene

    2015-01-01

    Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ?3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR ? 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7–6.7; median follow-up 6.1 y, range 0.3–9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was ?2 (interquartile range –4 to 2). There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events), rising to 1:47 and 1:6 in the medium (risk score 0–4, 103 events) and high risk groups (risk score ? 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166–3,367); NNTH was 202 (95% CI 159–278) and 21 (95% CI 19–23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506–1462), 88 (95% CI 69–121), and 9 (95% CI 8–10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3–12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6–8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD. PMID:25826420

  18. Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile

    Scientific Electronic Library Online (English)

    Alberto, Fica; Nicolás, Bunster; Felipe, Aliaga; Felipe, Olivares; Lorena, Porte; Stephanie, Braun; Jeannette, Dabanch; Juan Carlos, Hormázabal; Antonio, Hernández; María Guacolda, Benavides.

    2014-04-01

    Full Text Available AIMS: Bacteremic pneumococcal pneumonia (BPP) is a severe condition. To evaluate seasonal distribution, mortality, serotype frequencies, antimicrobial susceptibility, and different severity scores among patients with BPP. PATIENTS AND METHODS: Patients were identified by laboratory data and restr [...] icted to adulthood. Standard methods were used for serotyping and antimicrobial susceptibility. Risk factors were analyzed by univariate and multivariate methods. Severity scores (APACHE II, CURB-65 and CAP PIRO) were compared using ROC curves. RESULTS: Sixty events of community-acquired BPP occurred between 2005 and 2010. A seasonal pattern was detected. Mean age was 72.1 years old (81.4% >60 years). All had a predisposing factor. Previous influenza (3.3%) or pneumococcal immunization (1.7%) was infrequent. Admission to critical units was required by 51.7%. Twenty-two serotypes were identified among 59 strains. Only one strain had intermediate resistance to penicillin (1.7%). In-hospital mortality reached 33.3%. Multivariate analysis identified a CAP PIRO score>3 (OR 29.7; IC95 4.7-187), age >65 years (OR 42.1; IC95 2.2-796), and a platelet count

  19. Association of a Body Mass Index Genetic Risk Score with Growth throughout Childhood and Adolescence

    Science.gov (United States)

    Wu, Yan Yan; Timpson, Nicholas J.; Tilling, Kate; Pennell, Craig E.; Newnham, John; Davey-Smith, George; Palmer, Lyle J.; Beilin, Lawrence J.; Lye, Stephen J.; Lawlor, Debbie A.; Briollais, Laurent

    2013-01-01

    Background While the number of established genetic variants associated with adult body mass index (BMI) is growing, the relationships between these variants and growth during childhood are yet to be fully characterised. We examined the association between validated adult BMI associated single nucleotide polymorphisms (SNPs) and growth trajectories across childhood. We investigated the timing of onset of the genetic effect and whether it was sex specific. Methods Children from the ALSPAC and Raine birth cohorts were used for analysis (n?=?9,328). Genotype data from 32 adult BMI associated SNPs were investigated individually and as an allelic score. Linear mixed effects models with smoothing splines were used for longitudinal modelling of the growth parameters and measures of adiposity peak and rebound were derived. Results The allelic score was associated with BMI growth throughout childhood, explaining 0.58% of the total variance in BMI in females and 0.44% in males. The allelic score was associated with higher BMI at the adiposity peak (females ?=? 0.0163 kg/m2 per allele, males ?=? 0.0123 kg/m2 per allele) and earlier age (-0.0362 years per allele in males and females) and higher BMI (0.0332 kg/m2 per allele in females and 0.0364 kg/m2 per allele in males) at the adiposity rebound. No gene:sex interactions were detected for BMI growth. Conclusions This study suggests that known adult genetic determinants of BMI have observable effects on growth from early childhood, and is consistent with the hypothesis that genetic determinants of adult susceptibility to obesity act from early childhood and develop over the life course. PMID:24244521

  20. Fasting Hyperglycemia Increases In-Hospital Mortality Risk in Nondiabetic Female Patients with Acute Myocardial Infarction: A Retrospective Study

    OpenAIRE

    Luo, Guojing; Liu, Hong; Luo, Shunkui; Li, Fang; Su, Minhong; Lu, Hongyun

    2014-01-01

    Previous studies had shown that elevated admission plasma glucose (APG) could increase mortality rate and serious complications of acute myocardial infarction (AMI), but whether fasting plasma glucose (FPG) had the same role remains controversial. In this retrospective study, 253 cases of AMI patients were divided into diabetic (n = 87) and nondiabetic group (n = 166). Our results showed that: compared with the nondiabetic patients, diabetic patients had higher APG, FPG, higher plasma triglyc...

  1. Traditional cardiovascular risk factors in unselected patients with acute myocardial infarction - impact on short-term mortality.

    Czech Academy of Sciences Publication Activity Database

    Monhart, Z.; Faltus, Václav; Grünfeldová, Hana; Janský, P.

    2008-01-01

    Ro?. 117, ?. 19 (2008), s. 21-21. ISSN 0009-7322. [The 2008 World Congress on Cardiology. 18.05.2008-21.05.2008, Buenos Aires] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : acute myocardial infarction * evidence-based medication * mortality Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  2. Influence of an elevated nutrition risk score (NRS) on survival in patients following gastrectomy for gastric cancer.

    Science.gov (United States)

    Bachmann, J; Müller, T; Schröder, A; Riediger, C; Feith, M; Reim, D; Friess, H; Martignoni, M E

    2015-07-01

    In the last years, the impact of weight loss in patients with malignant tumors has come more and more into the focus of clinical research, as the occurrence of weight loss is often associated with a reduced survival. Weight loss can be a hint for metastases in patients suffering from malignant tumors; furthermore, these patients are usually not able to be treated with chemotherapy. The aim of the study was to show the influence of weight loss and an elevated nutrition risk score on survival following tumor resection in patients suffering from gastric cancer. In 99 patients in whom a gastrectomy due to gastric cancer was performed, the nutrition risk score was calculated and its influence on mortality, morbidity and survival was analyzed. Of the included patients, 45 % of the patients gave a history of weight loss; they had significantly more often a NRS ? 3. In UICC stage 1a/b, a NRS ? 3 was associated with a significantly reduced survival compared to patients with a NRS < 3. In early tumor stages (UICC 1a/b), a NRS ? 3 was associated with a significantly reduced survival, while in progressed tumor stage, the influence of a poor NRS was not significant. This seems to show that in progressed stages in patients with gastric cancer, the influence of a reduced NRS is negligible. PMID:26071123

  3. Myocardial infarction

    International Nuclear Information System (INIS)

    sup(99m)Tc-pyrophosphate (PYP) scintigraphy and 201Tl myocardial scintigraphy were utilized for the diagnoses of the presence, the region, and the extent of myocardial infarction. Exercise 201Tl myocardial scintigrams and exercise radionuclide ventriculography were utilized for diagnosis of coronary artery lesions in angina pectoris. Radionuclide ventriculography was used to investigate effects of coronary artery lesions on cardiac function and hemodynamics. In order to select adequate treatments for myocardial infarction and estimate the prognosis, it was necessary to detect the presence, the region, and the extent of acute myocardial infarction and to investigate effects of partial infarction on hemodynamics by using radionuclide imaging. Exercise myocardial scintigraphy could be carried out noninvasively and repeatedly for diagnosis of coronal artery disease. Therefore, this method could be applied widely. It was possible to use this method as a screening test of coronary artery diseases for the diagnoses of asymptomatic patients who showed ST changes in ECG, the patients with cardiac neurosis and the patency after a reconstructive surgery of coronary artery. (Tsunoda, M.)

  4. The UCSF Cancer of the Prostate Risk Assessment (CAPRA) Score: a straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy

    Science.gov (United States)

    Cooperberg, Matthew R.; Pasta, David J.; Elkin, Eric P.; Litwin, Mark S.; Latini, David M.; DuChane, Janeen; Carroll, Peter R.

    2010-01-01

    Purpose Multivariate prognostic instruments aim to predict risk of recurrence among patients with localized prostate cancer. We sought to devise a novel risk assessment tool which would be a strong predictor of outcome across various levels of risk, and which could be easily applied and intuitively understood. Materials and Methods We studied 1,439 men who had undergone radical prostatectomy and were followed in the CaPSURE database (a longitudinal, community-based disease registry of prostate cancer patients) diagnosed between 1992 and 2001 were included. Disease recurrence was defined as prostate specific antigen (PSA) ?0.2 ng/ml on 2 consecutive occasions following prostatectomy, or a second cancer treatment more than six months after surgery. The UCSF-CAPRA score was developed using pre-operative PSA, Gleason score, clinical T-stage, biopsy results, and age. The index was developed and validated using Cox proportional hazards and life table analyses. Results 210 patients (15%) recurred, 145 by PSA criteria and 65 by second treatment. Based on the results of the Cox analysis, points were assigned based on PSA (0-4 points), Gleason score (0-3), T stage (0-1), age (0-1), and biopsy data (0-1). The CAPRA score range is 0 to 10, with roughly double the risk of recurrence for each 2-point increase in score. Recurrence-free survival at 5 years ranged from 85% for a CAPRA score of 0-1 (95% CI 73-92%) to 8% for a score of 7-10 (95% CI 0-28%). The concordance index for the CAPRA score was 0.66. Conclusions The UCSF-CAPRA score is a straightforward yet powerful preoperative risk assessment tool. It must be externally validated in future studies. PMID:15879786

  5. A Risk Score for Predicting 1-Year Mortality in Patients ?75 Years of Age Presenting With Non-ST-Elevation Acute Coronary Syndrome.

    Science.gov (United States)

    Angeli, Fabio; Cavallini, Claudio; Verdecchia, Paolo; Morici, Nuccia; Del Pinto, Maurizio; Petronio, Anna Sonia; Antonicelli, Roberto; Murena, Ernesto; Bossi, Irene; De Servi, Stefano; Savonitto, Stefano

    2015-07-15

    Approximately 1/3 of patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS) are ?75 years of age. Risk stratification in these patients is generally difficult because supporting evidence is scarce. The investigators developed and validated a simple risk prediction score for 1-year mortality in patients ?75 years of age presenting with NSTE ACS. The derivation cohort was the Italian Elderly ACS trial, which included 313 patients with NSTE ACS aged ?75 years. A logistic regression model was developed to predict 1-year mortality. The validation cohort was a registry cohort of 332 patients with NSTE ACS meeting the same inclusion criteria as for the Italian Elderly ACS trial but excluded from the trial for any reason. The risk score included 5 statistically significant covariates: previous vascular event, hemoglobin level, estimated glomerular filtration rate, ischemic electrocardiographic changes, and elevated troponin level. The model allowed a maximum score of 6. The score demonstrated a good discriminating power (C statistic = 0.739) and calibration, even among subgroups defined by gender and age. When validated in the registry cohort, the scoring system confirmed a strong association with the risk for all-cause death. Moreover, a score ?3 (the highest baseline risk group) identified a subset of patients with NSTE ACS most likely to benefit from an invasive approach. In conclusion, the risk for 1-year mortality in patients ?75 years of age with NSTE ACS is substantial and can be predicted through a score that can be easily derived at the bedside at hospital presentation. The score may help in guiding treatment strategy. PMID:25978978

  6. Factores de riesgo para la ocurrencia de infarto agudo del miocardio en pacientes fumadores / Risk factors for occurrence of acute myocardial infarction in smokers patients

    Scientific Electronic Library Online (English)

    José Antonio, González Pompa; José Manuel, González Pérez.

    2013-12-01

    Full Text Available Introducción: las enfermedades cardiovasculares son la principal causa de muerte en diferentes países. Objetivo: evaluar el efecto de factores de riesgo en la ocurrencia del infarto agudo del miocardio en pacientes fumadores, en una población venezolana. Métodos: se realizó un estudio de casos y tes [...] tigos, la muestra se seleccionó de forma aleatoria y estuvo integrada por 70 casos y 70 testigos. Se estudiaron factores sociodemográficos y premórbidos y hábitos tóxicos. El análisis estádístico se basó en una estrategia univariada con la determinación del odd ratio para cada uno de los factores de riesgo hipotéticamente influyente y sus intervalos de confianza para el 95 %, finalmente, un estudio multivariado para determinar el valor independiente de cada uno de los factores de riesgos. Resultados: según el análisis univariado, todos los factores constituyeron riesgo para la aparición de la enfermedad. En el análisis multivariado, se encontró que la hipercolesterolemia elevó en 4,2 veces el riesgo de ocurrencia del infarto del miocardio (OR 4,20; IC 1,18-14,97) en la población de fumadores, seguido del tiempo de evolución del hábito de fumar (OR 3,60; IC 1,468,91) y del consumo de cigarrillos (OR 2,32; IC 1,02- 4,95). Conclusiones: la hipercolesterolemia tiene un efecto mayor sobre la posible ocurrencia de tener un infarto del miocardio que el del resto de los factores de riesgo estudiados en pacientes fumadores, de ahí que es el factor de mayor peso e importancia. Abstract in english Introduction: cardiovascular diseases are the main causes of death in many countries. Objective: to evaluate the occurrence of acute myocardial infarction in smoking patients in a Venezuelan population section. Methods: a case-control study was carried out with a randomly selected sample of 70 cases [...] and 70 controls. Sociodemographic and premorbid factors as well as toxic habits were studied. The statistical analysis was based on univariate strategy with odd ratios estimated for every hypothetically influential risk factor and their confidence intervals of 95 %. Finally, a multivariate study determined the independent value of each risk factor. Results: in the univariate analysis, all factors represented a risk for the onset of acute myocardial infarction. Hypercholesterolemia was the main risk factor in the multivariate analysis, since it increased the risk of myocardial infarction by 4.2 times (OR 4.20 CI 1.18- 14.97), followed by the length of the smoking habit (OR 3.60 CI 1.46 8.91) and the quantity of cigarettes smoked daily (OR 2.32; IC 1.02 4.95). Conclusions: hypercholesterolemia has greater effect on possible occurrence of myocardial infarction than the rest of risk factors studied in smoking patients; therefore it is the most significant factor.

  7. Risk markers of late high-degree atrioventricular block in patients with left ventricular dysfunction after an acute myocardial infarction: a CARISMA substudy

    DEFF Research Database (Denmark)

    Gang, Uffe Jakob Ortved; JØns, Christian

    2011-01-01

    AIMS: High-degree atrioventricular block (HAVB) after acute myocardial infarction (AMI) is associated with increased risk of mortality. Risk markers and predictors of HAVB occurring after AMI are largely unknown. The aim of this study was to assess the predictive value of risk markers derived from a series of non-invasive and invasive tests for the development of HAVB documented by an implantable loop recorder (ILR) in late convalescent phases of an AMI. METHODS AND RESULTS: The study included 292 patients with AMI and subsequent left ventricular dysfunction without prior HAVB or implanted pacemaker. An ILR was implanted for continuous arrhythmia surveillance. Risk stratification testing was performed at inclusion and 6 weeks after AMI. The tests included echocardiography, electrocardiogram (ECG), 24 h Holter monitoring, and an invasive electrophysiological study. High-degree atrioventricular block was documented in 28 (10%) patients during a median follow-up of 2.0 (0.4-2.0) years. Heart rate variability (HRV) measures and non-sustained ventricular tachycardia occurring at the week 6 Holter monitoring were highly predictive of HAVB. Power law slope <-1.5 ms(2)/Hz was the most powerful HRV parameter (HR = 6.02 [2.08-17.41], P < 0.001). CONCLUSION: Late HAVB development in post-AMI patients with left ventricular dysfunction can be predicted by risk stratification tests. Measures of HRV reflecting autonomic dysfunction revealed the highest predictive capabilities.

  8. A melanoma risk score in a Brazilian population / Um escore de risco para melanoma em uma população brasileira

    Scientific Electronic Library Online (English)

    Lucio, Bakos; Simeona, Mastroeni; Renan Rangel, Bonamigo; Franco, Melchi; Paolo, Pasquini; Cristina, Fortes.

    2013-04-01

    Full Text Available FUNDAMENTOS: importantes fatores de risco para melanoma cutâneo são reconhecidos, mas escores padronizados para avaliação individual ainda precisam ser elaborados. OBJETIVOS: o objetivo deste estudo foi desenv [...] olver um escore de risco de melanoma cutâneo para uma amostra brasileira. MÉTODOS: verificar as estimativas dos principais fatores de risco para melanoma, derivado de uma meta-análise (estudo de base italiano) e, externamente, validar em uma população do sul do Brasil por um estudo caso-controle. Um total de 117 indivíduos foram avaliados. RESULTADOS: a variável com maior poder preditivo para o risco de melanoma cutâneo na população estudada foi a cor do cabelo (AUC: 0,71, IC 95%: 0,62-0,79). Outros fatores importantes para o modelo foram: sardas, queimaduras solares, e cor de pele e cor dos olhos. Adicionando outras variáveis, como os nevos comuns, elastose, história familiar e lesões pré-malignas não houve melhora da capacidade preditiva. CONCLUSÃO: A capacidade discriminatória do modelo proposto mostrou-se superior ou comparável aos modelos de risco anteriores propostos para melanoma cutâneo. Abstract in english BACKGROUND: Important risk factors for cutaneous melanoma (CM) are recognized, but standardized scores for individual assessment must still be developed. OBJECTIVES: The objective of this study was to develop [...] a risk score of CM for a Brazilian sample. METHODS: To verify the estimates of the main risk factors for melanoma, derived from a meta-analysis (Italian-based study), and externally validate them in a population in southern Brazil by means of a case-control study. A total of 117 individuals were evaluated. Different models were constructed combining the summary coefficients of different risk factors, derived from the meta-analysis, multiplied by the corresponding category of each variable for each participant according to a mathematical expression. RESULTS: the variable that best predicted the risk of CM in the studied population was hair color (AUC: 0.71; 95% CI: 0.62-0.79). Other important factors were freckles, sunburn episodes, and skin and eye color. Consideration of other variables such as common nevi, elastosis, family history, and premalignant lesions did not improve the predictive ability of the models. CONCLUSION: The discriminating capacity of the proposed model proved to be superior or comparable to that of previous risk models proposed for CM.

  9. A melanoma risk score in a Brazilian population Um escore de risco para melanoma em uma população brasileira

    Directory of Open Access Journals (Sweden)

    Lucio Bakos

    2013-04-01

    Full Text Available BACKGROUND: Important risk factors for cutaneous melanoma (CM are recognized, but standardized scores for individual assessment must still be developed. OBJECTIVES: The objective of this study was to develop a risk score of CM for a Brazilian sample. METHODS: To verify the estimates of the main risk factors for melanoma, derived from a meta-analysis (Italian-based study, and externally validate them in a population in southern Brazil by means of a case-control study. A total of 117 individuals were evaluated. Different models were constructed combining the summary coefficients of different risk factors, derived from the meta-analysis, multiplied by the corresponding category of each variable for each participant according to a mathematical expression. RESULTS: the variable that best predicted the risk of CM in the studied population was hair color (AUC: 0.71; 95% CI: 0.62-0.79. Other important factors were freckles, sunburn episodes, and skin and eye color. Consideration of other variables such as common nevi, elastosis, family history, and premalignant lesions did not improve the predictive ability of the models. CONCLUSION: The discriminating capacity of the proposed model proved to be superior or comparable to that of previous risk models proposed for CM. FUNDAMENTOS: importantes fatores de risco para melanoma cutâneo são reconhecidos, mas escores padronizados para avaliação individual ainda precisam ser elaborados. OBJETIVOS: o objetivo deste estudo foi desenvolver um escore de risco de melanoma cutâneo para uma amostra brasileira. MÉTODOS: verificar as estimativas dos principais fatores de risco para melanoma, derivado de uma meta-análise (estudo de base italiano e, externamente, validar em uma população do sul do Brasil por um estudo caso-controle. Um total de 117 indivíduos foram avaliados. RESULTADOS: a variável com maior poder preditivo para o risco de melanoma cutâneo na população estudada foi a cor do cabelo (AUC: 0,71, IC 95%: 0,62-0,79. Outros fatores importantes para o modelo foram: sardas, queimaduras solares, e cor de pele e cor dos olhos. Adicionando outras variáveis, como os nevos comuns, elastose, história familiar e lesões pré-malignas não houve melhora da capacidade preditiva. CONCLUSÃO: A capacidade discriminatória do modelo proposto mostrou-se superior ou comparável aos modelos de risco anteriores propostos para melanoma cutâneo.

  10. Sex differences in the risk profile and male predominance in silent brain infarction in community-dwelling elderly subjects. The Sefuri brain MRI study

    International Nuclear Information System (INIS)

    Although brain infarction is more common in men, the male predominance of silent brain infarction (SBI) was inconsistent in the earlier studies. This study was to examine the relationship between sex differences in the risk profile and SBI. We conducted a population-based, cross-sectional analysis of cardiovascular risk factors and SBI on MRI. We asked all the female participants about the age at natural menopause and parity. SBI was detected in 77 (11.3%) of 680 participants (266 men and 414 women) with a mean age of 64.5 (range 40-93) years. In the logistic analysis, age (odds ratio (OR)=2.760/10 years, 95% confidence interval (CI)=2.037-3.738), hypertension (OR=3.465, 95% CI=1.991-6.031), alcohol intake (OR=2.494, 95% CI=1.392-4.466) and smoking (OR=2.302, 95% CI=1.161-4.565) were significant factors concerning SBI. Although SBI was more prevalent among men, this sex difference disappeared on the multivariate model after adjustment for other confounders. In 215 women aged 60 years or older, age at natural menopause, early menopause, duration of menopause, number of children and age at the last parity were not significantly associated with SBI after adjustment for age. Hypertension and age were considered to be the major risk factors for SBI in community-dwelling people. Male predominance in SBI was largely due to higher prevalence of alcohol habit and smoking in men than in women in our population. (author)

  11. Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Gorgels Anton PM

    2011-03-01

    Full Text Available Abstract Background Few studies investigated the association between smoking, alcohol consumption, or physical activity and the risk of unstable angina pectoris (UAP, while the strength of these associations may differ compared to other coronary diseases such as acute myocardial infarction (AMI. Therefore, we investigated whether the associations of these lifestyle factors with UAP differed from those with AMI. Additionally, we investigated whether these effects differed between subjects with and without a family history of myocardial infarction (MI. Methods The CAREMA study consists of 21,148 persons, aged 20-59 years at baseline and randomly sampled from the Maastricht region in 1987-1997. At baseline, all participants completed a self-administered questionnaire. After follow-up of maximally 16.9 years, 420 AMI and 274 UAP incident cases were registered. Incidence rate ratios (RRs were estimated using Cox proportional hazards models. Results For both diseases, smoking increased the risk while alcohol consumption was associated with a protective effect. Associations with both risk factors were stronger for AMI than UAP, although this difference was only statistically significant for smoking. In men, an inverse association was found with physical activity during leisure time which seemed to be stronger for the risk of UAP than of AMI. On the contrary, physical activity during leisure time was associated with an increased risk of both AMI and UAP in women which seemed to be weaker for UAP than for AMI. Except for occupational physical activity in women, no significant interactions on a multiplicative scale were found between the lifestyle factors and family history of MI. Nevertheless, the highest risks were found in subjects with both a positive family history and the most unfavorable level of the lifestyle factors. Conclusions The strength of the associations with the lifestyle factors did not differ between AMI and UAP, except for smoking. Furthermore, the effects of the lifestyle factors on the risk of both coronary diseases were similar for subjects with and without a positive family history.

  12. Behavioral Mechanisms, Elevated Depressive Symptoms, and the Risk for Myocardial Infarction or Death in Individuals with Coronary Heart Disease (A Reason for Geographic and Racial Differences in Stroke [REGARDS] Study)

    Science.gov (United States)

    Ye, Siqin; Muntner, Paul; Shimbo, Daichi; Judd, Suzanne E; Richman, Joshua; Davidson, Karina W; Safford, Monika M

    2012-01-01

    Objective To determine whether behavioral mechanisms explain the association between depressive symptoms and myocardial infarction (MI) or death in individuals with coronary heart disease (CHD). Background Depressive symptoms are associated with increased morbidity and mortality in individuals with CHD, but it is unclear how much behavioral mechanisms contribute to this association. Methods The study included 4,676 participants with a history of CHD. Elevated depressive symptoms were defined as scores ?4 on the Center for Epidemiologic Studies Depression 4-item Scale. The primary outcome was definite/probable MI or death from any cause. Incremental proportional hazards models were constructed by adding demographics, comorbidities and medications, then four behavioral mechanisms (alcohol use, smoking, physical inactivity, and medication non-adherence). Results At baseline, 638 (13.6%) participants had elevated depressive symptoms. Over a median 3.8 years of follow up, 125 of 638 (19.6%) participants with and 657 of 4038 (16.3%) without elevated depressive symptoms had events. Higher risk of MI or death was observed for elevated depressive symptoms after adjusting for demographics (hazard ratio [HR] 1.41, 95% CI 1.15–1.72), but was no longer significant after adjusting for behavioral mechanisms (HR 1.14, 95% CI 0.93–1.40). The four behavioral mechanisms together significantly attenuated the risk for MI or death conveyed by elevated depressive symptoms (?36.9%, 95% CI ?18.9 to ?119.1%), with smoking (?17.6%, 95% CI ?6.5% to ?56.0%) and physical inactivity (?21.0%, 95% CI ?9.7% to ?61.1%) having the biggest explanatory roles. Conclusion Our findings suggest potential roles for behavioral interventions targeting smoking and physical inactivity in patients with CHD and comorbid depression. PMID:23290548

  13. Relation of nonalcoholic Fatty liver disease and framingham risk score to flow-mediated dilation in patients with cardiometabolic risk factors.

    Science.gov (United States)

    Pastori, Daniele; Loffredo, Lorenzo; Perri, Ludovica; Baratta, Francesco; Scardella, Laura; Polimeni, Licia; Pani, Arianna; Brancorsini, Monica; Albanese, Fabiana; Catasca, Elisa; Del Ben, Maria; Violi, Francesco; Angelico, Francesco

    2015-05-15

    Nonalcoholic fatty liver disease (NAFLD) has a high prevalence in the general population. Brachial artery flow-mediated dilation (FMD) is a surrogated marker of early atherosclerosis. Few data investigating the relation between FMD, NAFLD, and cardiovascular (CV) risk are available. We recruited 367 consecutive outpatients with cardiometabolic risk factors who underwent ultrasound scanning for liver steatosis and FMD. Mean age was 54.2 ± 12.2 years, and 37% were women. NAFLD was present in 281 patients (77%). Median FMD was 5.1%. FMD was significantly reduced in patients with NAFLD (p fasting blood glucose (Rs, -0.204; p fasting blood glucose (?, -0.148; p = 0.008), age (?, -0.158; p = 0.005), and the presence of NAFLD (?, -0.132; p = 0.016) inversely correlated with FMD, whereas female gender predicted a better FMD (?, 0.125; p = 0.022). FMD and Framingham Risk Score (FRS) were inversely correlated (Rs, -0.183; p 20; FMD, 3.3% [1.7% to 4.5%]) risk, FMD significantly decreased across risk classes of FRS (p = 0.003). At multivariate regression analysis, both FRS (?, -0.129; p = 0.016) and NAFLD (?, -0.218; p <0.001) were variables independently associated with FMD. In conclusion, the presence of NAFLD and FRS inversely correlated with FMD. PMID:25776455

  14. A Hypertension Risk Score for Middle-Aged and Older Adults

    OpenAIRE

    Kshirsagar, Abhijit V.; Chiu, Ya-lin; Bomback, Andrew S.; August, Phyllis A.; Viera, Anthony J.; Colindres, Romulo E.; Bang, Heejung

    2010-01-01

    Determining which demographic and medical variables predict the development of hypertension could help clinicians stratify risk in both prehypertensive and nonhypertensive persons. Subject-level data from 2 community-based biracial cohorts were combined to ascertain the relationship between baseline characteristics and incident hypertension. Hypertension, defined as diastolic blood pressure ?90 mm Hg, systolic blood pressure ?140 mm Hg, or reported use of medication known to treat hyperte...

  15. To Construct A Forecasting Model of the Anthropometric Chronic Disease Risk Factor Score

    OpenAIRE

    Yi-Chou Chuang; Ming-Hsu Wang; Ding-Hau Huang; Chien-Hsin Yang; Jen-Der Lin

    2006-01-01

    Background: Many health indices have a relationship with anthropometric indices. Thisresearch attempts to provide a new measurement: a chronic disease risk factorscore built into the regression model. This new model will help peoplevisualize their health status and get multiple information during the processof the healthy examination.Methods: Data from 8,034 subjects were collected from the data bank of the HealthExamination Center in Chang Gung Memorial Hospital. Related anthropometricindice...

  16. Evaluation of primary androgen deprivation therapy in prostate cancer patients using the J-CAPRA risk score

    Science.gov (United States)

    Akaza, Hideyuki; Hinotsu, Shiro; Usami, Michiyuki; Ogawa, Osamu; Kitamura, Tadaichi; Suzuki, Kazuhiro; Tsukamoto, Taiji; Naito, Seiji; Namiki, Mikio; Hirao, Yoshihiko; Murai, Masaru

    2013-01-01

    Purpose: To determine the influence of maximal androgen blockade (MAB) and non-MAB hormonal therapy with an luteinizing hormone releasing hormone (LHRH) analog on overall survival of prostate cancer patients in the Japan Study Group of Prostate Cancer (J-CaP) registry according to risk, as assessed using the novel J-CAPRA risk instrument. To undertake a multivariate analysis combining J-CAPRA risk score, type of hormonal therapy and comorbidities, in order to assess their impact on overall survival. Methods: The J-CaP database includes men in Japan diagnosed with any stage of prostate cancer between 2001 and 2003 and treated with primary androgen deprivation therapy (PADT), as monotherapy or in combination. A total of 26,272 men were enrolled and of these 19,265 were treated with PADT. This analysis was undertaken using the latest data set (30 April, 2010) including a total of 15,727 patients who received PADT and had follow-up data for periods ranging from 0 to 9.2 years. Results: MAB for prostate cancer patients with intermediate- or high-risk disease has a significant benefit in terms of overall survival compared with LHRH analog monotherapy or surgical castration alone. Better results may be achieved in older (?75 years) patients. Patient comorbidities are an important factor in determining overall survival, notably in older patients, and should be considered when selecting therapy. Conclusions: Based on large-scale registry data, this report is the first to analyze the outcomes of MAB therapy in patients with prostate cancer at a wide range of disease stages. MAB therapy may provide significant survival benefits in intermediate- and high-risk patients. PMID:24223407

  17. Genetic Risk Scores Associated with Baseline Lipoprotein Subfraction Concentrations Do Not Associate with Their Responses to Fenofibrate

    Directory of Open Access Journals (Sweden)

    Alexis C. Frazier-Wood

    2014-08-01

    Full Text Available Lipoprotein subclass concentrations are modifiable markers of cardiovascular disease risk. Fenofibrate is known to show beneficial effects on lipoprotein subclasses, but little is known about the role of genetics in mediating the responses of lipoprotein subclasses to fenofibrate. A recent genomewide association study (GWAS associated several single nucleotide polymorphisms (SNPs with lipoprotein measures, and validated these associations in two independent populations. We used this information to construct genetic risk scores (GRSs for fasting lipoprotein measures at baseline (pre-fenofibrate, and aimed to examine whether these GRSs also associated with the responses of lipoproteins to fenofibrate. Fourteen lipoprotein subclass measures were assayed in 817 men and women before and after a three week fenofibrate trial. We set significance at a Bonferroni corrected alpha <0.05 (p < 0.004. Twelve subclass measures changed with fenofibrate administration (each p = 0.003 to <0.0001. Mixed linear models which controlled for age, sex, body mass index (BMI, smoking status, pedigree and study-center, revealed that GRSs were associated with eight baseline lipoprotein measures (p < 0.004, however no GRS was associated with fenofibrate response. These results suggest that the mechanisms for changes in lipoprotein subclass concentrations with fenofibrate treatment are not mediated by the genetic risk for fasting levels.

  18. Validação de um novo escore de risco cirúrgico para cirurgia valvar: VMCP Validación de un nuevo score de riesgo quirúrgico para cirugía valvular: VMCP Validation of a new surgical risk score for heart valve surgery: VMCP

    Directory of Open Access Journals (Sweden)

    Max Grinberg

    2009-04-01

    Full Text Available FUNDAMENTO: Alguns estudos desenvolveram escores para avaliar o risco cirúrgico, particularmente o EuroSCORE que, entretanto, é complexo e trabalhoso. Sugerimos um escore novo e simples, mais adequado para a prática clínica e para a avaliação de risco cirúrgico em pacientes valvopatas. OBJETIVO: Este estudo foi realizado para criar e validar um escore simples e prático para predizer mortalidade e morbidade em cirurgia valvar. MÉTODOS: Coletamos dados hospitalares de 764 pacientes e realizamos a validação do escore, utilizando dois modelos estatísticos: óbito (= mortalidade e tempo de internação hospitalar (TIH > 10 dias (= morbidade. O escore foi composto de quatro índices (V [lesão valvar], M [função miocárdica], C [doença arterial coronariana] e P [pressão da artéria pulmonar]. Estabelecemos um valor de corte para o escore, e foram utilizadas análises uni e multivariada para confirmar se o escore seria capaz de predizer mortalidade e morbidade. Também estudamos se havia associação com outros fatores de risco. RESULTADOS: O escore foi validado, com boa consistência interna (0,65, e o melhor valor de corte para mortalidade e morbidade foi 8. O escore com valor > 8 pode predizer TIH > 10 dias (odds ratio (OR = 1,7 p=0,006, e um maior risco de óbito ao menos na análise univariada (p=0,049. Entretanto, o risco de óbito não foi previsível na análise multivariada (p=0,258. CONCLUSÃO: O escore VMCP > 8 pode predizer TIH > 10 dias e pode ser usado como uma nova ferramenta para o seguimento de pacientes portadores de valvopatia submetidos a cirurgia.FUNDAMENTO: Algunos estudos desarrollaron scores para evaluar el riesgo quirúrgico, particularmente el EuroSCORE que, sin embargo, es complejo y de difícil aplicación. Sugerimos una puntuación nueva y sencilla, más adecuada para la práctica clínica y para la evaluación de riesgo quirúrgico en pacientes con valvulopatías. OBJETIVO: Se realizó este estudio con el objetivo de crear y validar un score sencillo y práctico para predecir mortalidad y morbilidad en cirugía valvular. MÉTODOS: Recoleccionamos datos hospitalarios de 764 pacientes y realizamos la validación del score, con la utilización de dos modelos estadísticos: óbito (= mortalidad y tiempo de internación hospitalaria (TIH > 10 días (= morbilidad. El score estaba conpuesto por cuatro índicadores (V [lesión valvular], M [función miocárdica], C [enfermedad arterial coronaria] y P [presión de la arteria pulmonar]. Establecemos un valor de corte para el score, y utilizamos el análisis uni y multivariado para confirmar si la puntuación sería capaz de predecir mortalidad y morbilidad. También investigamos si había asociación con otros factores de riesgo. RESULTADOS: Se validó el score, con satisfactoria consistencia interna (0,65. El mejor valor de corte para mortalidad y morbilidad fue 8. El score con valor > 8 es adecuado para predecir tanto el TIH > 10 días (odds ratio (OR = 1,7 p=0,006, como un mayor riesgo de óbito, por lo menos en el análisis univariado (p=0,049. No obstante, el riesgo de óbito no se mostró previsible en el análisis multivariado (p=0,258. CONCLUSIÓN: El score VMCP > 8 es adecuado para predecir TIH > 10 días, y se puede utilizarlo como una nueva herramienta para el seguimiento de pacientes portadores de valvulopatía sometidos a cirugía.BACKGROUND: Some studies have developed scores for the assessment of surgical risk, particularly the EuroSCORE, which, however, is complex and difficult to apply. We suggest a new and simpler score, which is more appropriate for the clinical practice and for the assessment of surgical risk in patients with heart valve diseases. OBJECTIVE: This study was conducted to create and validate a simple and practical score to predict mortality and morbidity related to heart valve surgery. METHODS: Hospital data from 764 patients were collected, and the score was validated using two statistical models: death (= mortality and length of hospital stay (LHS > 10 days (= morbidity. The score was co

  19. Prevalence of diabetes mellitus and the performance of a risk score among Hindustani Surinamese, African Surinamese and ethnic Dutch: a cross-sectional population-based study

    Directory of Open Access Journals (Sweden)

    Michels Bob PJ

    2008-08-01

    Full Text Available Abstract Background While the prevalence of type 2 diabetes mellitus (DM is high, tailored risk scores for screening among South Asian and African origin populations are lacking. The aim of this study was, first, to compare the prevalence of (known and newly detected DM among Hindustani Surinamese, African Surinamese and ethnic Dutch (Dutch. Second, to develop a new risk score for DM. Third, to evaluate the performance of the risk score and to compare it to criteria derived from current guidelines. Methods We conducted a cross-sectional population based study among 336 Hindustani Surinamese, 593 African Surinamese and 486 Dutch, aged 35–60 years, in Amsterdam. Logistic regressing analyses were used to derive a risk score based on non-invasively determined characteristics. The diagnostic accuracy was assessed by the area under the Receiver-Operator Characteristic curve (AUC. Results Hindustani Surinamese had the highest prevalence of DM, followed by African Surinamese and Dutch: 16.7, 8.1, 4.2% (age 35–44 and 35.0, 19.0, 8.2% (age 45–60, respectively. The risk score included ethnicity, body mass index, waist circumference, resting heart rate, first-degree relative with DM, hypertension and history of cardiovascular disease. Selection based on age alone showed the lowest AUC: between 0.57–0.62. The AUC of our score (0.74–0.80 was higher than that of criteria from guidelines based solely on age and BMI and as high as criteria that required invasive specimen collection. Conclusion In Hindustani Surinamese and African Surinamese populations, screening for DM should not be limited to those over 45 years, as is advocated in several guidelines. If selective screening is indicated, our ethnicity based risk score performs well as a screening test for DM among these groups, particularly compared to the criteria based on age and/or body mass index derived from current guidelines.

  20. Predicting the Risk for Hospital-Onset Clostridium difficile Infection (HO-CDI) at the Time of Inpatient Admission: HO-CDI Risk Score.

    Science.gov (United States)

    Tabak, Ying P; Johannes, Richard S; Sun, Xiaowu; Nunez, Carlos M; McDonald, L Clifford

    2015-06-01

    OBJECTIVE To predict the likelihood of hospital-onset Clostridium difficile infection (HO-CDI) based on patient clinical presentations at admission DESIGN Retrospective data analysis SETTING Six US acute care hospitals PATIENTS Adult inpatients METHODS We used clinical data collected at the time of admission in electronic health record (EHR) systems to develop and validate a HO-CDI predictive model. The outcome measure was HO-CDI cases identified by a nonduplicate positive C. difficile toxin assay result with stool specimens collected >48 hours after inpatient admission. We fit a logistic regression model to predict the risk of HO-CDI. We validated the model using 1,000 bootstrap simulations. RESULTS Among 78,080 adult admissions, 323 HO-CDI cases were identified (ie, a rate of 4.1 per 1,000 admissions). The logistic regression model yielded 14 independent predictors, including hospital community onset CDI pressure, patient age ?65, previous healthcare exposures, CDI in previous admission, admission to the intensive care unit, albumin ?3 g/dL, creatinine >2.0 mg/dL, bands >32%, platelets ?150 or >420 109/L, and white blood cell count >11,000 mm3. The model had a c-statistic of 0.78 (95% confidence interval [CI], 0.76-0.81) with good calibration. Among 79% of patients with risk scores of 0-7, 19 HO-CDIs occurred per 10,000 admissions; for patients with risk scores >20, 623 HO-CDIs occurred per 10,000 admissions (P<.0001). CONCLUSION Using clinical parameters available at the time of admission, this HO-CDI model demonstrated good predictive ability, and it may have utility as an early risk identification tool for HO-CDI preventive interventions and outcome comparisons. Infect Control Hosp Epidemiol 2015;00(0):1-7. PMID:25753106

  1. Lack of association of two common polymorphisms on 9p21 with risk of coronary heart disease and myocardial infarction; results from a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Hofman Albert

    2008-10-01

    Full Text Available Abstract Background Recent genome wide association (GWA studies identified two Single Nucleotide Polymorphisms (SNP (rs10757278 and rs10757274 in the region of the CDK2NA and CDK2NB genes to be consistently associated with the risks of coronary heart disease (CHD and myocardial infarction (MI. We examined the SNPs in relation to the risk of CHD and MI in a large population based study of elderly population. Methods The Rotterdam Study is a population-based, prospective cohort study among 7983 participants aged 55 years and older. Associations of the polymorphisms with CHD and MI were assessed by use of Cox proportional hazards analyses. Results In an additive model, the age and sex adjusted hazard ratios (HRs (95% confidence interval for CHD and MI were 1.03 (0.90, 1.18 and 0.94 (0.82, 1.08 per copy of the G allele of rs10757274. The corresponding HRs were 1.03 (0.90, 1.18 and 0.93 (0.81, 1.06 for the G allele of rs10757278. The association of the SNPs with CHD and MI was not significant in any of the subgroups of CHD risk factors. Conclusion we were not able to show an association of the studied SNPs with risks of CHD and MI. This may be due to differences in genes involved in the occurrence of CHD in young and older people.

  2. Iatrogenic opioid dependence is endemic and legal: Genetic addiction risk score (GARS) with electrotherapy a paradigm shift in pain treatment programs

    OpenAIRE

    Kenneth Blum; David Han; Marlene Oscar-Berman; Gary Reinl; Nicholas DiNubile; Madigan, Margaret A.; Anish Bajaj; Bernard William Downs; John Giordano; Wayne Westcott; Leonard Smith; Braverman, Eric R.; Kristina Dushaj; Mary Hauser; Thomas Simpatico

    2013-01-01

    The mounting endemic of prescription iatrogenic opioid dependence in pain patients provoked this treatise about an alternative method that can be used to treat pain, improve function and reduce the risk of opioid dependence. It is well known that as well as the side effects reported for chronic opioid therapy, genetically predisposed individuals are at risk for opioid dependence. We propose the use of the Genetic Addiction Risk Score (GARS) assessment to identify patients early in treatment w...

  3. Riesgo individual y poblacional en infarto agudo del miocardio: Estudio INTERHEART Chile / Individual and population risk in acute myocardial infarction: The Chilean INTERHEART study

    Scientific Electronic Library Online (English)

    Fernando, Lanas; Sergio, Potthoff; Enrique, Mercadal; Claudio, Santibáñez; Alejandra, Lanas; Dina, Standen.

    2008-05-01

    Full Text Available [...] Abstract in english Acute myocardial infarction (AMI) is the first cause of death in Chile. Aim To assess the magnitude of risk of individuals and population associated with AMI risk factors. Material and methods: Case control study with incident cases and 2 controls paired by age and gender. History of diabetes, hyper [...] tension, smoking, stress, depression, diet, weight, height, hip and waist circumference, apolipoprotein (Apo) Al and B were determined. Odds ratio (OR) and population attributable risk (PAR) were calculated with 95% confidence interval. Results: Three hundred thirty two cases and 672 controls were included. Mean age was 61.6±12 years and 22% were women. The higher individual risk was associated with smoking: OR 3.1 (2.3-4.2), hypertension: 2.9 (2.1-3.9), permanent stress: 2.2 (1,3-2,8), increased apoB/ApoAl ratio: 2.1 (1.4-3.0) and diabetes: 2.0 (1.4-2.9). A protective effect of daily consumption of vegetables and/or fruits with and OR of 0.54 (0.4-0.8), was observed. The highest PAR was due to smoking: 42% (33.2-51.4), increased ApoB/ApoAl ratio: 35.2 (19.0-55.8) and hypertension: 32% (24.5-40.8). These three factors explained 71.3% of the AMI risk in Chile. A moderate effect on PAR was observed for abdominal obesity: 16.6% (2.4-61.2), permanent stress: 12.0% (2.3-44.1) and diabetes: 10.8% (6.1-18.3). Conclusions: Known risk factors ¡ike dyslipidemia, smoking and hypertension explain most of the AMI cases in Chile. The control of these risk factors should have a major effect on morbidity and mortality due to coronary artery disease in our country

  4. Riesgo individual y poblacional en infarto agudo del miocardio: Estudio INTERHEART Chile Individual and population risk in acute myocardial infarction: The Chilean INTERHEART study

    Directory of Open Access Journals (Sweden)

    Fernando Lanas

    2008-05-01

    Full Text Available Acute myocardial infarction (AMI is the first cause of death in Chile. Aim To assess the magnitude of risk of individuals and population associated with AMI risk factors. Material and methods: Case control study with incident cases and 2 controls paired by age and gender. History of diabetes, hypertension, smoking, stress, depression, diet, weight, height, hip and waist circumference, apolipoprotein (Apo Al and B were determined. Odds ratio (OR and population attributable risk (PAR were calculated with 95% confidence interval. Results: Three hundred thirty two cases and 672 controls were included. Mean age was 61.6±12 years and 22% were women. The higher individual risk was associated with smoking: OR 3.1 (2.3-4.2, hypertension: 2.9 (2.1-3.9, permanent stress: 2.2 (1,3-2,8, increased apoB/ApoAl ratio: 2.1 (1.4-3.0 and diabetes: 2.0 (1.4-2.9. A protective effect of daily consumption of vegetables and/or fruits with and OR of 0.54 (0.4-0.8, was observed. The highest PAR was due to smoking: 42% (33.2-51.4, increased ApoB/ApoAl ratio: 35.2 (19.0-55.8 and hypertension: 32% (24.5-40.8. These three factors explained 71.3% of the AMI risk in Chile. A moderate effect on PAR was observed for abdominal obesity: 16.6% (2.4-61.2, permanent stress: 12.0% (2.3-44.1 and diabetes: 10.8% (6.1-18.3. Conclusions: Known risk factors ¡ike dyslipidemia, smoking and hypertension explain most of the AMI cases in Chile. The control of these risk factors should have a major effect on morbidity and mortality due to coronary artery disease in our country

  5. Changes in physical activity in leisure time and the risk of myocardial infarction, ischemic heart disease, and all-cause mortality

    DEFF Research Database (Denmark)

    Petersen, Christina BjØrk; GrØnbæk, Morten

    2012-01-01

    Physical activity is associated to a lower risk of mortality from all-causes and from coronary heart disease. The long-term effects of changes in physical activity on coronary heart disease are, however, less known. We examined the association between changes in leisure time physical activity and the risk of myocardial infarction (MI), ischemic heart disease (IHD), and all-cause mortality as well as changes in blood pressure in 4,487 men and 5,956 women in the Copenhagen City Heart Study. Physical activity was measured in 1976-1978 and 1981-1983 and participants were followed in nation-wide registers until 2009. Men who decreased physical activity by at least two levels and women who decreased by one level had a higher risk of MI relatively to an unchanged physical activity level (hazard ratio [HR] = 1.74, 95% confidence interval [95% CI]: 1.17-2.60 and HR = 1.30, 95% CI: 1.03-1.65). Similar associations were found for IHD although only significant in women. In all-cause mortality, men who increased physical activity had a lower risk and both men and women who reduced physical activity had a higher risk compared to an unchanged physical activity level. No association between changes in physical activity and blood pressure was observed. Findings from this prospective study suggest that changes in physical activity affect the risk of MI, IHD and all-cause mortality. A decrease in physical activity was associated to a higher risk of coronary heart disease.

  6. Transulnar sheathless percutaneous coronary intervention during bivalirudin infusion in high-risk elderly female with non-ST segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Marina Mustilli

    2012-06-01

    Full Text Available Due to the ageing population and raised life expectancy, elderly patients are increasingly referred for percutaneous coronary intervention (PCI during acute coronary syndromes (ACS. Bleeding complications are not infrequent during ACS, occurring in 2-5% of patients with prognostic and economic consequences. In particular, periprocedural bleeding and vascular complications are associated with worse clinical outcome, prolonged hospital stay and increased short- and long-term mortality, especially in elderly patients with acute coronary syndromes. We report the case of an 83-year old female referred to our hospital because of non-ST segment elevation myocardial infarction with high bleeding risk and unsuitable radial artery undergoing transulnar sheathless PCI during bivalirudin infusion. The clinical, technical, pharmacological and prognostic implications are discussed.

  7. Association of urinary cadmium and myocardial infarction

    International Nuclear Information System (INIS)

    We conducted a cross-sectional analysis of individuals 45-79 years old in the National Health and Nutrition Examination Survey III (1988-1994) (NHANES III). Myocardial infarction was determined by electrocardiogram (ECG). Our sample included 4912 participants, which when weighted represented 52,234,055 Americans. We performed adjusted logistic regressions with the Framingham risk score, pack-years of smoking, race-ethnicity, and family history of heart attack, and diabetes as covariates. Urinary cadmium ?0.88 ?g/g creatinine had an odds ratio of 1.86 (95% CI 1.26-2.75) compared to urinary cadmium <0.43 ?g/g creatinine. This result supports the hypothesis that cadmium is associated with coronary heart disease. When logistic regressions were done by gender, women, but not men, showed a significant association of urinary cadmium with myocardial infarction. Women with urinary cadmium ?0.88 ?g/g creatinine had an odds ratio of 1.80 (95% CI 1.06-3.04) compared to urinary cadmium <0.43 ?g/g creatinine. When the analysis was restricted to never smokers (N=2187) urinary cadmium ?0.88 ?g/g creatinine had an odds ratio of 1.85 (95% CI 1.10-3.14) compared to urinary cadmium <0.43 ?g/g creatinine

  8. Incidence and Risk Factors of Ventricular Fibrillation Before Primary Angioplasty in Patients With First ST-Elevation Myocardial Infarction : A Nationwide Study in Denmark

    DEFF Research Database (Denmark)

    Jabbari, Reza; EngstrØm, Thomas

    2015-01-01

    BACKGROUND: We aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST-segment elevation myocardial infarction (STEMI) in a prospective nationwide setting. METHODS AND RESULTS: In this case-control study, patients presenting within the first 12 hours of first STEMI who survived to undergo angiography and subsequent PPCI were enrolled. Over 2 years, 219 cases presenting with VF before PPCI and 441 controls without preceding VF were enrolled. Of the 219 case patients, 182 (83%) had STEMI with out-of-hospital cardiac arrest due to VF, and 37 (17%) had cardiac arrest upon arrival to the emergency room. Medical history was collected by standardized interviews and by linkage to national electronic health records. The incidence of VF before PPCI among STEMI patients was 11.6%. Multivariable logistic regression analysis identified novel associations between atrial fibrillation and alcohol consumption with VF. Patients with a history of atrial fibrillation had a 2.80-fold odds of experiencing VF before PPCI (95% CI 1.10 to 7.30). Compared with nondrinkers, patients who consumed 1 to 7 units, 8 to 14 units, or >15 units of alcohol per week had an odds ratio (OR) of 1.30 (95% CI, 0.80 to 2.20), 2.30 (95% CI, 1.20 to 4.20), or 3.30 (95% CI, 1.80 to 5.90), respectively, for VF. Previously reported associations for preinfarction angina (OR 0.46; 95% CI 0.32 to 0.67), age of <60 years (OR 1.75; 95% CI 1.20 to 2.60), anterior infarction (OR 2.10; 95% CI 1.40 to 3.00), preprocedural thrombolysis in myocardial infarction flow grade 0 (OR 1.65; 95% CI 1.14 to 2.40), and family history of sudden death (OR 1.60; 95% CI 1.10 to 2.40) were all associated with VF. CONCLUSION: Several easily assessed risk factors were associated with VF occurring out-of-hospital or on arrival at the emergency room before PPCI in STEMI patients, thus providing potential avenues for investigation regarding improved identification and prevention of life-threatening ventricular arrhythmias.

  9. Incidence and risk factors of ventricular fibrillation before primary angioplasty in patients with first ST-elevation myocardial infarction : a nationwide study in Denmark

    DEFF Research Database (Denmark)

    Jabbari, Reza; EngstrØm, Thomas

    2015-01-01

    BACKGROUND: We aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST-segment elevation myocardial infarction (STEMI) in a prospective nationwide setting. METHODS AND RESULTS: In this case-control study, patients presenting within the first 12 hours of first STEMI who survived to undergo angiography and subsequent PPCI were enrolled. Over 2 years, 219 cases presenting with VF before PPCI and 441 controls without preceding VF were enrolled. Of the 219 case patients, 182 (83%) had STEMI with out-of-hospital cardiac arrest due to VF, and 37 (17%) had cardiac arrest upon arrival to the emergency room. Medical history was collected by standardized interviews and by linkage to national electronic health records. The incidence of VF before PPCI among STEMI patients was 11.6%. Multivariable logistic regression analysis identified novel associations between atrial fibrillation and alcohol consumption with VF. Patients with a history of atrial fibrillation had a 2.80-fold odds of experiencing VF before PPCI (95% CI 1.10 to 7.30). Compared with nondrinkers, patients who consumed 1 to 7 units, 8 to 14 units, or >15 units of alcohol per week had an odds ratio (OR) of 1.30 (95% CI, 0.80 to 2.20), 2.30 (95% CI, 1.20 to 4.20), or 3.30 (95% CI, 1.80 to 5.90), respectively, for VF. Previously reported associations for preinfarction angina (OR 0.46; 95% CI 0.32 to 0.67), age of <60 years (OR 1.75; 95% CI 1.20 to 2.60), anterior infarction (OR 2.10; 95% CI 1.40 to 3.00), preprocedural thrombolysis in myocardial infarction flow grade 0 (OR 1.65; 95% CI 1.14 to 2.40), and family history of sudden death (OR 1.60; 95% CI 1.10 to 2.40) were all associated with VF. CONCLUSION: Several easily assessed risk factors were associated with VF occurring out-of-hospital or on arrival at the emergency room before PPCI in STEMI patients, thus providing potential avenues for investigation regarding improved identification and prevention of life-threatening ventricular arrhythmias.

  10. Validação de um novo escore de risco cirúrgico para cirurgia valvar: VMCP / Validation of a new surgical risk score for heart valve surgery: VMCP / Validación de un nuevo score de riesgo quirúrgico para cirugía valvular: VMCP

    Scientific Electronic Library Online (English)

    Max, Grinberg; Vívian Masutti, Jonke; Roney Orismar, Sampaio; Guilherme Sobreira, Spina; Flavio, Tarasoutchi.

    2009-04-01

    Full Text Available FUNDAMENTO: Alguns estudos desenvolveram escores para avaliar o risco cirúrgico, particularmente o EuroSCORE que, entretanto, é complexo e trabalhoso. Sugerimos um escore novo e simples, mais adequado para a prática clínica e para a avaliação de risco cirúrgico em pacientes valvopatas. OBJETIVO: Est [...] e estudo foi realizado para criar e validar um escore simples e prático para predizer mortalidade e morbidade em cirurgia valvar. MÉTODOS: Coletamos dados hospitalares de 764 pacientes e realizamos a validação do escore, utilizando dois modelos estatísticos: óbito (= mortalidade) e tempo de internação hospitalar (TIH) > 10 dias (= morbidade). O escore foi composto de quatro índices (V [lesão valvar], M [função miocárdica], C [doença arterial coronariana] e P [pressão da artéria pulmonar]). Estabelecemos um valor de corte para o escore, e foram utilizadas análises uni e multivariada para confirmar se o escore seria capaz de predizer mortalidade e morbidade. Também estudamos se havia associação com outros fatores de risco. RESULTADOS: O escore foi validado, com boa consistência interna (0,65), e o melhor valor de corte para mortalidade e morbidade foi 8. O escore com valor > 8 pode predizer TIH > 10 dias (odds ratio (OR) = 1,7 p=0,006), e um maior risco de óbito ao menos na análise univariada (p=0,049). Entretanto, o risco de óbito não foi previsível na análise multivariada (p=0,258). CONCLUSÃO: O escore VMCP > 8 pode predizer TIH > 10 dias e pode ser usado como uma nova ferramenta para o seguimento de pacientes portadores de valvopatia submetidos a cirurgia. Abstract in spanish FUNDAMENTO: Algunos estudos desarrollaron scores para evaluar el riesgo quirúrgico, particularmente el EuroSCORE que, sin embargo, es complejo y de difícil aplicación. Sugerimos una puntuación nueva y sencilla, más adecuada para la práctica clínica y para la evaluación de riesgo quirúrgico en pacien [...] tes con valvulopatías. OBJETIVO: Se realizó este estudio con el objetivo de crear y validar un score sencillo y práctico para predecir mortalidad y morbilidad en cirugía valvular. MÉTODOS: Recoleccionamos datos hospitalarios de 764 pacientes y realizamos la validación del score, con la utilización de dos modelos estadísticos: óbito (= mortalidad) y tiempo de internación hospitalaria (TIH) > 10 días (= morbilidad). El score estaba conpuesto por cuatro índicadores (V [lesión valvular], M [función miocárdica], C [enfermedad arterial coronaria] y P [presión de la arteria pulmonar]). Establecemos un valor de corte para el score, y utilizamos el análisis uni y multivariado para confirmar si la puntuación sería capaz de predecir mortalidad y morbilidad. También investigamos si había asociación con otros factores de riesgo. RESULTADOS: Se validó el score, con satisfactoria consistencia interna (0,65). El mejor valor de corte para mortalidad y morbilidad fue 8. El score con valor > 8 es adecuado para predecir tanto el TIH > 10 días (odds ratio (OR) = 1,7 p=0,006), como un mayor riesgo de óbito, por lo menos en el análisis univariado (p=0,049). No obstante, el riesgo de óbito no se mostró previsible en el análisis multivariado (p=0,258). CONCLUSIÓN: El score VMCP > 8 es adecuado para predecir TIH > 10 días, y se puede utilizarlo como una nueva herramienta para el seguimiento de pacientes portadores de valvulopatía sometidos a cirugía. Abstract in english BACKGROUND: Some studies have developed scores for the assessment of surgical risk, particularly the EuroSCORE, which, however, is complex and difficult to apply. We suggest a new and simpler score, which is more appropriate for the clinical practice and for the assessment of surgical risk in patien [...] ts with heart valve diseases. OBJECTIVE: This study was conducted to create and validate a simple and practical score to predict mortality and morbidity related to heart valve surgery. METHODS: Hospital data from 764 patients were collected, and the score was validated using two statistical models: death (= mo

  11. Combination of High Ankle–Brachial Index and Hard Coronary Heart Disease Framingham Risk Score in Predicting the Risk of Ischemic Stroke in General Population

    Science.gov (United States)

    Wang, Tong; Kong, Minyi; Chen, Renhua; Liu, Yu; Chen, Jianping; Wang, Zhiyu; Wang, Jingfeng; Huang, Hui

    2014-01-01

    Our previous study showed that the patients with more metabolic risk factors had higher risk of high ankle–brachial index (ABI), but the relationship between high ABI and the risk of severe cardiovascular and cerebrovascular diseases is still under debate. This study aims to evaluate this association in the general population. 1486 subjects of South China were recruited in the study. 61 subjects were defined as high ABI group (ABI?1.3) and 65 subjects were randomly selected as normal ABI group (0.9heart disease (HCHD) Framingham Risk Score (FRS) were compared between two groups. The results showed that the 10-year HCHD FRS of high ABI group was significantly higher than normal ABI group (7.87±6.11 vs. 3.98±2.90%, Pischemic stroke was higher in high ABI group than normal ABI group (21.3% vs. 6.2%, Pischemic stroke was higher in participants with high ABI and HCHD FRS?6% than those with normal ABI and HCHD FRSischemic stroke in the general population of South China. PMID:25198106

  12. Trends in Cardiovascular Disease Risk Factor Prevalence and Estimated 10-Year Cardiovascular Risk Scores in a Large Untreated French Urban Population: The CARVAR 92 Study

    Science.gov (United States)

    Karam, Carma; Beauchet, Alain; Czernichow, Sebastien; de Roquefeuil, Florence; Bourez, Alain; Mansencal, Nicolas; Dubourg, Olivier

    2015-01-01

    Background Surveys measuring effectiveness of public awareness campaigns in reducing cardiovascular disease (CVD) incidence have yielded equivocal findings. The aim of this study was to describe cardiovascular risk factors (CVRFs) changes over the years in an untreated population-based study. Methods Between 2007 and 2012, we conducted a screening campaign for CVRFs in men aged 40 to 65 yrs and women aged 50 to 70 yrs in the western suburbs of Paris. Data were complete for 20,324 participants of which 14,709 were untreated. Results The prevalence trend over six years was statistically significant for hypertension in men from 25.9% in 2007 to 21.1% in 2012 (p=0.002) and from 23% in 2007 to 12.7% in 2012 in women (p<0.0001). The prevalence trend of tobacco smoking decreased from 38.6% to 27.7% in men (p=0.0001) and from 22.6% to 16.8% in women (p=0.113). The Framingham 10-year risk for CVD decreased from 13.3 ± 8.2 % in 2007 to 11.7 ± 9.0 % in 2012 in men and from 8.0 ± 4.1 % to 5.9 ± 3.4 % in women. The 10-year risk of fatal CVD based on the European Systematic COronary Risk Evaluation (SCORE) decreased in men and in women (p <0.0001). Conclusions Over a 6-year period, several CVRFs have decreased in our screening campaign, leading to decrease in the 10-year risk for CVD and the 10-year risk of fatal CVD. Cardiologists should recognize the importance of community prevention programs and communication policies, particularly tobacco control and healthier diets to decrease the CVRFs in the general population. PMID:25906186

  13. Metabolic syndrome and dietary components are associated with coronary artery disease risk score in free-living adults: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Takahashi Mauro

    2011-05-01

    Full Text Available Abstract Background Coronary artery disease (CAD is among the main causes of death in developed countries, and diet and lifestyle can influence CAD incidence. Objective To evaluate the association of coronary artery disease risk score with dietary, anthropometric and biochemical components in adults clinically selected for a lifestyle modification program. Methods 362 adults (96 men, 266 women, 53.9 ± 9.4 years fulfilled the inclusion criteria by presenting all the required data. The Framingham score was calculated and the IV Brazilian Guideline on Dyslipidemia and Prevention of Atherosclerosis was adopted for classification of the CAD risks. Anthropometric assessments included waist circumference (WC, body fat and calculated BMI (kg/m2 and muscle-mass index (MMI kg/m2. Dietary intake was estimated through 24 h dietary recall. Fasting blood was used for biochemical analysis. Metabolic Syndrome (MS was diagnosed using NCEP-ATPIII (2001 criteria. Logistic regression was used to determine the odds of CAD risks according to the altered components of MS, dietary, anthropometric, and biochemical components. Results For a sample with a BMI 28.5 ± 5.0 kg/m2 the association with lower risk ( Conclusion Recommended intake of saturated fat and dietary fiber, together with proper muscle mass, are inversely associated with CAD risk score. On the other hand, the presence of MS and high plasma uric acid are associated with CAD risk score.

  14. Body composition and body fat distribution in relation to later risk of acute myocardial infarction: a Danish follow-up study

    DEFF Research Database (Denmark)

    Stegger, Jakob; Schmidt, E B

    2011-01-01

    Introduction:Obesity is a modifiable risk factor for acute myocardial infarction (MI), but lean body mass (LBM) may also be an important factor. Low LBM may increase the risk of MI and LBM may modify the effect of obesity on MI. Thus, the inability of the classical anthropometric measures to evaluate LBM may lead to misclassification of MI risk in both lean and obese persons. We investigated the associations between incident MI and bioelectrical impedance analyses (BIA) derived measures of body composition in combination with body mass index (BMI) and anthropometric measures of body fat distribution.Methods and results:From 1993 to 1997, 27?148 men and 29?863 women, aged 50 to 64 year, were recruited into the Danish prospective study Diet, Cancer and Health. During 11.9 years of follow-up we identified 2028 cases of incident MI (1487 men and 541 women). BMI, waist circumference (WC), hip circumference and BIA of body composition including body fat mass (BFM), body fat percentage and LBM were measured at baseline. We used Cox proportional hazard models with age as time axis and performed extensive control for confounding. Weight, BMI, classical estimates of abdominal obesity and BIA estimates of obesity showed significant positive associations with incident MI. However, BFM adjusted for WC showed no association. Low LBM was associated with a higher risk of incident MI in both genders, and high LBM was associated with a higher risk in men.Conclusion:Obesity was positively associated with MI. Estimates of obesity achieved by BIA seemed not to add additional information to classical anthropometric measures regarding MI risk. Both high and low LBM may be positively associated with MI.International Journal of Obesity advance online publication, 1 February 2011; doi:10.1038/ijo.2010.278.

  15. How Much of the Recent Decline in the Incidence of Myocardial Infarction in British Men Can Be Explained by Changes in Cardiovascular Risk Factors?

    Science.gov (United States)

    Hardoon, Sarah L.; Whincup, Peter H.; Lennon, Lucy T.; Wannamethee, S. Goya; Capewell, Simon; Morris, Richard W.

    2011-01-01

    Background The incidence of myocardial infarction (MI) in Britain has fallen markedly in recent years. Few studies have investigated the extent to which this decline can be explained by concurrent changes in major cardiovascular risk factors. Methods and Results The British Regional Heart Study examined changes in cardiovascular risk factors and MI incidence over 25 years from 1978 in a cohort of 7735 men. During this time, the age-adjusted hazard of MI decreased by 3.8% (95% confidence interval 2.6% to 5.0%) per annum, which corresponds to a 62% decline over the 25 years. At the same time, after adjustment for age, cigarette smoking prevalence, mean systolic blood pressure, and mean non–high-density lipoprotein (HDL) cholesterol decreased, whereas mean HDL cholesterol, mean body mass index, and physical activity levels rose. No significant change occurred in alcohol consumption. The fall in cigarette smoking explained the greatest part of the decline in MI incidence (23%), followed by changes in blood pressure (13%), HDL cholesterol (12%), and non-HDL cholesterol (10%). In combination, 46% (approximate 95% confidence interval 23% to 164%) of the decline in MI could be explained by these risk factor changes. Physical activity and alcohol consumption had little influence, whereas the increase in body mass index would have produced a rise in MI risk. Conclusions Modest favorable changes in the major cardiovascular risk factors appear to have contributed to considerable reductions in MI incidence. This highlights the potential value of population-wide measures to reduce exposure to these risk factors in the prevention of coronary heart disease. PMID:18212284

  16. Long-term use of non-steroidal anti-inflammatory drugs and the risk of myocardial infarction in the general population

    Directory of Open Access Journals (Sweden)

    González-Pérez Antonio

    2005-11-01

    Full Text Available Abstract Background Recent data indicate that chronic use of coxibs leads to an increased occurrence of thrombotic cardiovascular events. This raises the question as to whether traditional non-steroidal anti-inflammatory drugs (tNSAIDs might also produce similar hazards. Our aim has been to evaluate the association between the chronic use of tNSAIDs and the risk of myocardial infarction (MI in patients. Methods We performed a nested case-control analysis with 4,975 cases of acute MI and 20,000 controls, frequency matched to cases by age, sex, and calendar year. Results Overall, current use of tNSAID was not associated with an increased risk of MI (RR:1.07;95%CI: 0.95–1.21. However, we found that the relative risk (RR of MI for durations of tNSAID treatment of >1 year was 1.21 (95% CI, 1.00–1.48. The corresponding RR was 1.34 (95% CI, 1.06–1.70 for non-fatal MI. The effect was independent from dose. The small risk associated with long-term use of tNSAIDs was observed among patients not taking low-dose aspirin (RR: 1.29; 95% CI, 1.01–1.65. The effect of long-term use for individual tNSAIDs ranged from a RR of 0.87 (95% CI, 0.47–1.62 with naproxen to 1.38 (95% CI, 1.00–1.90 with diclofenac. Conclusion This study adds support to the hypothesis that chronic treatment with some tNSAIDs is associated with a small increased risk of non-fatal MI. Our data are consistent with a substantial variability in cardiovascular risks between individual tNSAIDs.

  17. Cardiac sympathetic dysfunction contributes to left ventricular remodelling after acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Sakata, K.; Mochizuki, M.; Yoshida, H.; Nawada, R.; Ohbayashi, K.; Ishikawa, J.; Tamekiyo, H. [Dept. of Cardiology, Shizuoka General Hospital, Shizuoka (Japan)

    2000-11-01

    To investigate the role of the cardiac sympathetic nervous system in left ventricular remodelling, 50 patients with first-time acute myocardial infarction (AMI) and patency of the infarct-related artery after reperfusion underwent quantitative iodine-123 metaiodobenzylguanidine (MIBG) imaging at 4 days and 4 weeks (n=42), and quantitative technetium-99m tetrofosmin imaging at 2 days after AMI. They also underwent both ventriculography and coronary angiography on admission and about 4 weeks after AMI. On the basis of left ventricular end-systolic volume (LVESV), patients were divided into two groups. Patients with LVESV dilatation (n=20) had a significantly lower ejection fraction (P<0.003) and a significantly higher severity score of {sup 99m}Tc-tetrofosmin (P<0.04), and total severity (P<0.01), {delta} extent (P<0.007) and {delta} severity (P<0.0008) scores of MIBG than patients without LVESV dilatation (n=30). {delta} severity score of MIBG was directly correlated with change in LVESV at 4 weeks (r=0.63, P<0.0001). Stepwise linear discriminant function analysis showed that {delta} severity score of MIBG (P<0.0002) was the only discriminator of LVESV dilatation. Patients with LVESV dilatation had higher regional washout rates in both the infarct and the non-infarct zones than patients without such dilatation. Furthermore, no MIBG parameters changed significantly between 4 days and 4 weeks after AMI. In reperfused AMI, {delta} severity score of MIBG was related to the degree of ventricular dilatation and was the only powerful discriminator of ventricular dilatation. These results suggest that cardiac sympathetic nervous abnormality might contribute to left ventricular remodelling in reperfused AMI. MIBG imaging may allow identification of reperfused AMI patients at high risk for left ventricular remodelling. (orig.)

  18. The association of lifetime education with the prevalence of myocardial infarction: an analysis of the 2006 Behavioral Risk Factor Surveillance System.

    Science.gov (United States)

    Kelly, Michael J; Weitzen, Sherry

    2010-02-01

    Socioeconomic status is likely an independent risk factor for coronary heart disease but little research has been done in the United States to study this association in a nationally representative sample. We sought to determine the association between lifetime education and the prevalence of myocardial infarction (MI) among adults over the age of 39 in the US. A cross sectional study was conducted using the 2006 Behavioral Risk Factor Surveillance System (BRFSS). A multivariable logistic regression was performed. The analysis was conducted in 2008. Among respondents aged 40 years and older to the 2006 BRFSS survey those with less than a high school education had 3.09 (95% CI: 2.79-3.43) times the odds of having had an MI compared to college graduates. After adjusting for confounders, respondents with less than a high school education had 1.61 (95% CI: 1.41-1.83) times the odds of having had an MI compared to college graduates. Both those with a high school education and those who completed some college or technical school had 1.22 times the odds of having had an MI compared to college graduates after adjusting for confounders. This study suggests that education is a risk factor for MI. More national prospective studies are needed in the US to better understand the link between socioeconomic status and coronary heart disease. PMID:19949844

  19. Right ventricular involvement with acute inferior wall myocardial infarction identifies high risk of developing atrioventricular nodal conduction disturbances

    International Nuclear Information System (INIS)

    In 67 consecutive patients with inferior wall acute myocardial infarction (AMI), 99m-technetium pyrophosphate scintigraphy was performed 36 to 72 hours after the onset of chest pain to detect right ventricular (RV) involvement. All patients were continuously monitored during at least 3 days to detect rhythm and conduction disturbances. In 29 patients RV involvement was diagnosed by scintigraphy. None of these 29 patients showed clinical signs of right-sided heart failure. Fourteen of the 19 patients showing atrioventricular (AV) nodal condution disturbances in the setting of inferior AMI also had RV involvement. Therefore, the incidence of high-degree AV nodal block in patients with RV involvement (14 of 29 patients) was 48% compared to only 13% (5 of 38) in patients with inferior AMI without RV involvement

  20. High-Sensitivity C-Reactive Protein as a Predictor of Cardiovascular Events after ST-Elevation Myocardial Infarction

    Energy Technology Data Exchange (ETDEWEB)

    Ribeiro, Daniel Rios Pinto; Ramos, Adriane Monserrat; Vieira, Pedro Lima; Menti, Eduardo; Bordin, Odemir Luiz Jr.; Souza, Priscilla Azambuja Lopes de; Quadros, Alexandre Schaan de; Portal, Vera Lúcia, E-mail: veraportal.pesquisa@gmail.com [Programa de Pós-Graduação em Ciências da Saúde: Cardiologia - Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

    2014-07-15

    The association between high-sensitivity C-reactive protein and recurrent major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction who undergo primary percutaneous coronary intervention remains controversial. To investigate the potential association between high-sensitivity C-reactive protein and an increased risk of MACE such as death, heart failure, reinfarction, and new revascularization in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. This prospective cohort study included 300 individuals aged >18 years who were diagnosed with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention at a tertiary health center. An instrument evaluating clinical variables and the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores was used. High-sensitivity C-reactive protein was determined by nephelometry. The patients were followed-up during hospitalization and up to 30 days after infarction for the occurrence of MACE. Student's t, Mann-Whitney, chi-square, and logistic regression tests were used for statistical analyses. P values of ?0.05 were considered statistically significant. The mean age was 59.76 years, and 69.3% of patients were male. No statistically significant association was observed between high-sensitivity C-reactive protein and recurrent MACE (p = 0.11). However, high-sensitivity C-reactive protein was independently associated with 30-day mortality when adjusted for TIMI [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.07-1.51; p = 0.005] and GRACE (OR, 1.26; 95% CI, 1.06-1.49; p = 0.007) risk scores. Although high-sensitivity C-reactive protein was not predictive of combined major cardiovascular events within 30 days after ST-elevation myocardial infarction in patients who underwent primary angioplasty and stent implantation, it was an independent predictor of 30-day mortality.

  1. High-Sensitivity C-Reactive Protein as a Predictor of Cardiovascular Events after ST-Elevation Myocardial Infarction

    International Nuclear Information System (INIS)

    The association between high-sensitivity C-reactive protein and recurrent major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction who undergo primary percutaneous coronary intervention remains controversial. To investigate the potential association between high-sensitivity C-reactive protein and an increased risk of MACE such as death, heart failure, reinfarction, and new revascularization in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. This prospective cohort study included 300 individuals aged >18 years who were diagnosed with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention at a tertiary health center. An instrument evaluating clinical variables and the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores was used. High-sensitivity C-reactive protein was determined by nephelometry. The patients were followed-up during hospitalization and up to 30 days after infarction for the occurrence of MACE. Student's t, Mann-Whitney, chi-square, and logistic regression tests were used for statistical analyses. P values of ?0.05 were considered statistically significant. The mean age was 59.76 years, and 69.3% of patients were male. No statistically significant association was observed between high-sensitivity C-reactive protein and recurrent MACE (p = 0.11). However, high-sensitivity C-reactive protein was independently associated with 30-day mortality when adjusted for TIMI [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.07-1.51; p = 0.005] and GRACE (OR, 1.26; 95% CI, 1.06-1.49; p = 0.007) risk scores. Although high-sensitivity C-reactive protein was not predictive of combined major cardiovascular events within 30 days after ST-elevation myocardial infarction in patients who underwent primary angioplasty and stent implantation, it was an independent predictor of 30-day mortality

  2. Effects of epilepsy and selected antiepileptic drugs on risk of myocardial infarction, stroke, and death in patients with or without previous stroke: a nationwide cohort study

    DEFF Research Database (Denmark)

    Olesen, J. B.; Abildstrom, S. Z.

    2011-01-01

    Purpose Patients with epilepsy have increased morbidity and mortality. We evaluated the risk of myocardial infarction (MI), stroke, and death associated with epilepsy and examined if this risk was modified by treatment with antiepileptic drugs (AEDs). Methods A cohort consisting of the Danish population was followed from January 1997 to December 2006. The risk of MI, stroke, cardiovascular death, and all-cause death associated with epilepsy was estimated by multivariable Cox proportional hazard models stratified for occurrence of previous stroke. AED use was determined at baseline, and risks associated with exposure to individual AEDs were examined in patients with epilepsy. Results In patients without previous stroke, AED-treated epilepsy was associated with an increased risk of MI (hazard ratio [HR], 1.09; 95%CI, 1.00-1.19), stroke (HR, 2.22; 95%CI, 2.09-2.36), cardiovascular death (HR, 1.64; 95%CI, 1.57-1.72), and all-cause death (HR, 1.92; 95%CI, 1.86-1.97). Compared with carbamazepine monotherapy, valproate was associated with a decreased risk of MI (HR, 0.72; 95%CI, 0.59-0.87) and stroke (HR, 0.86; 95%CI, 0.76-0.96), oxcarbazepine and phenobarbital with increased risk of cardiovascular death (HR, 1.10; 95%CI, 1.02-1.19 and HR, 1.08; 95%CI, 1.00-1.17, respectively) and all-cause death (HR, 1.11; 95%CI, 1.05-1.18 and HR, 1.18; 95%CI, 1.12-1.25, respectively), and oxcarbazepine with increased risk of stroke (HR, 1.21; 95%CI, 1.10-1.34), in patients with epilepsy. Conclusions Patients with epilepsy exhibit increased risk of MI, stroke, cardiovascular death, and all-cause death. Compared with carbamazepine monotherapy, valproate may decrease, and oxcarbazepine and phenobarbital may increase, the risk of adverse cardiovascular events in these patients. Copyright (C) 2011 John Wiley & Sons, Ltd.

  3. Impact of obesity as a mortality predictor in high-risk patients with myocardial infarction or chronic heart failure: a pooled analysis of five registries

    DEFF Research Database (Denmark)

    Abdulla, Jawdat; KØber, Lars

    2008-01-01

    AIMS: To explore the influence of obesity on prognosis in high-risk patients with myocardial infarction (MI) or heart failure (HF). METHODS AND RESULTS: Individual data of 21 570 consecutively hospitalized patients from five Danish registries were pooled together. After a follow-up of 10.4 years, all-cause mortality using multivariate model and adjusted hazard ratios (HR) with 95% confidence intervals were calculated. Compared with normal weight [body mass index (BMI) 18.5-24.9 kg/m2], obesity class II (BMI >or= 35 kg/m2) was associated with increased risk of death in patients with MI but not HF [HR = 1.23 (1.06-1.44), P = 0.006 and HR = 1.13 (0.95-1.36), P = 0.95] (P-value for interaction = 0.004). Obesity class I (BMI 30-34.9 kg/m2) was not associated with increased risk of death in MI or HF [HR = 0.99 (0.92-1.08) and 1.00 (0.90-1.11), P > 0.1]. Pre-obesity (BMI 25-29.9 kg/m2) was associated with decreased death risk in MI but not HF [HR = 0.91 (0.87-0.96), P = 0.0006 and 1.04 (0.97-1.12), P = 0.34] (P-value for interaction = 0.007). Underweight (BMI < 18.5 kg/m2) patients were in increased death risk regardless of MI or HF [HR = 1.54 (1.35-1.75) and 1.37 (1.18-1.59), P < 0.001]. CONCLUSION: In patients with MI but not HF, the relationship between BMI and mortality is U-shaped with highest mortality in underweight and obese class II, but lowest in the other BMI classes.

  4. Knowledge of modifiable risk factors of heart disease among patients with acute myocardial infarction in Karachi, Pakistan: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Rasool Syed I

    2006-04-01

    Full Text Available Abstract Background Knowledge is an important pre-requisite for implementing both primary as well as secondary preventive strategies for cardiovascular disease (CVD. There are no estimates of the level of knowledge of risk factor of heart disease in patients with CVD. We estimated the level of knowledge of modifiable risk factors and determined the factors associated with good level of knowledge among patients presenting with their first acute myocardial infarction (AMI in a tertiary care hospital in Karachi, Pakistan. Methods A hospital based cross-sectional study was conducted at the National Institute of Cardiovascular Disease, a major tertiary care hospital in Karachi Pakistan. Patients admitted with their first AMI were eligible to participate. Standard questionnaire was used to interview 720 subjects. Knowledge of four modifiable risk factors of heart disease: fatty food consumption, smoking, obesity and exercise were assessed. The participants knowing three out of four risk factors were regarded as having a good level of knowledge. A multiple logistic regression model was constructed to identify the determinants of good level of knowledge. Results The mean age (SD was 54 (11.66 years. A mere 42% of our study population had a good level of knowledge. In multiple logistic regression analysis, independent predictors of "good" level of knowledge were (odds ratio [95% confidence interval] more than ten years of schooling were 2.5 [1.30, 4.80] (verses no schooling at all and nuclear family system (verses extended family system 2.54 [1.65, 3.89]. In addition, Sindhi ethnicity OR [3.03], higher level of exercise OR [2.76] and non user of tobacco OR [2.53] were also predictors of good level of knowledge. Conclusion Our findings highlight the lack of good level of knowledge of modifiable risk factors for heart disease among subjects admitted with AMI in Pakistan. There is urgent need for aggressive and targeted educational strategies in the Pakistani population.

  5. The Asp298 allele of endothelial nitric oxide synthase is a risk factor for myocardial infarction among patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Råstam Lennart

    2008-12-01

    Full Text Available Abstract Background Endothelial dysfunction plays a central role in atherosclerotic progression and cardiovascular complications of type 2 diabetes mellitus (T2DM. Given the role of nitric oxide in the vascular system, we aimed to test hypotheses of synergy between the common endothelial nitric oxide synthase (eNOS Asp298 allele and T2DM in predisposing to acute myocardial infarction (AMI. Methods In a population-based patient survey with 403 persons with T2DM and 799 healthy subjects from the population without diabetes or hypertension, we analysed the relation between T2DM, sex and the eNOS Asp298 allele versus the risk for AMI. Results In an overall analysis, T2DM was a significant independent risk factor for AMI. In patients with T2DM, homozygosity for the eNOS Asp298 allele was a significant risk factor (HR 3.12 [1.49–6.56], p = 0.003, but not in subjects without diabetes or hypertension. Compared to wild-type non-diabetic subjects, all patients with T2DM had a significantly increased risk of AMI regardless of genotype. This risk was however markedly higher in patients with T2DM homozygous for the Asp298 allele (HR 7.20 [3.01–17.20], p Conclusion We show here a strong independent association between eNOS genotype and AMI in patients with T2DM. This suggests a synergistic effect of the eNOS Asp298 allele and diabetes, and confirms the role of eNOS as an important pathological bottleneck for cardiovascular disease in patients with T2DM.

  6. Do factors in the psychosocial work environment mediate the effect of socioeconomic position on the risk of myocardial infarction? : Study from the Copenhagen Centre for Prospective Population Studies

    DEFF Research Database (Denmark)

    Andersen, I; Burr, H

    2004-01-01

    AIM: To investigate whether the effect of socioeconomic position on risk of myocardial infarction (MI) is mediated by differential exposure or differential susceptibility to psychosocial work environment. METHODS: Data were used from three prospective population studies conducted in Copenhagen. A total of 16 214 employees, 44% women, aged 20-75 years, with initial examination between 1974 and 1992 were followed until 1996 for incident (hospital admission or death) MI. Register based information on job categories was used. Psychosocial job exposures were measured indirectly by means of a job exposure matrix based on the Danish Work Environment Cohort Study 1990. RESULTS: During follow up, 731 subjects were diagnosed with an MI: 610 men and 121 women (35% fatal). The hazards by socioeconomic position showed a graded effect with a hazard ratio (HR) of 1.57 (95% CI 1.23 to 2.03) for unskilled workers compared to executive managers. Despite a strong and graded association in risk of MI related to decision authority and skill discretion, only skill discretion mediated the effect of socioeconomic position. The HR for unskilled workers was reduced to 1.47 (0.93 to 2.31) after adjustment for decision authority and other cardiovascular risk factors, and to 1.07 (0.72 to 1.60) after adjustment for skill discretion and cardiovascular risk factors. No sign of synergy was found. CONCLUSIONS: Decision authority and skill discretion were strongly related to socioeconomic position; and the effect on risk of MI was partially mediated by skill discretion. Improvements in psychosocial work environment, especially possibilities for skill discretion, might contribute to reducing the incidence of MI and social inequality in MI.

  7. A Weighted Polygenic Risk Score Using 14 Known Susceptibility Variants to Estimate Risk and Age Onset of Psoriasis in Han Chinese

    Science.gov (United States)

    Yin, Xianyong; Cheng, Hui; Lin, Yan; Wineinger, Nathan E.; Zhou, Fusheng; Sheng, Yujun; Yang, Chao; Li, Pan; Li, Feng; Shen, Changbing; Yang, Sen; Schork, Nicholas J.; Zhang, Xuejun

    2015-01-01

    With numbers of common variants identified mainly through genome-wide association studies (GWASs), there is great interest in incorporating the findings into screening individuals at high risk of psoriasis. The purpose of this study is to establish genetic prediction models and evaluate its discriminatory ability in psoriasis in Han Chinese population. We built the genetic prediction models through weighted polygenic risk score (PRS) using 14 susceptibility variants in 8,819 samples. We found the risk of psoriasis among individuals in the top quartile of PRS was significantly larger than those in the lowest quartile of PRS (OR = 28.20, P < 2.0×10-16). We also observed statistically significant associations between the PRS, family history and early age onset of psoriasis. We also built a predictive model with all 14 known susceptibility variants and alcohol consumption, which achieved an area under the curve statistic of ~ 0.88. Our study suggests that 14 psoriasis known susceptibility loci have the discriminating potential, as is also associated with family history and age of onset. This is the genetic predictive model in psoriasis with the largest accuracy to date. PMID:25933357

  8. Thrombotic stroke and myocardial infarction with hormonal contraception

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; LØkkegaard, Ellen

    2012-01-01

    Although several studies have assessed the risk of venous thromboembolism with newer hormonal contraception, few have examined thrombotic stroke and myocardial infarction, and results have been conflicting.

  9. Analysis of the association of a heat shock protein70-1 gene promoter polymorphism with myocardial infarction and coronary risk traits.

    Science.gov (United States)

    Bolla, M K; Miller, G J; Yellon, D M; Evans, A; Luc, G; Cambou, J P; Arveiler, D; Cambien, F; Latchman, D S; Humphries, S E; Day, I N

    1998-02-01

    Heat shock proteins (HSP) are induced during coronary ischaemia, and abnormal expression of one HSP gene may cause hypertension in rats. We examined association of a promoter polymorphism in the major stress-inducible hsp70 gene (hsp70-1 or HSP70A1) on chromosome 6 (p21.3) with coronary disease traits. This C-->A base substitution (AAACCCC) is at nucleotide position-110 in the heat shock transcription factor binding site (heat shock element, HSE). The first study sample (ECTIM), recruited from Belfast and three centers in France, consisted of 578 myocardial infarction cases and 698 age-matched controls. The frequency of the A-110 allele was 0.381 (95% CI = 0.35-0.41) and 0.384 (95% CI = 0.36-0.41) in cases and controls respectively. Homozygotes for the rarer A-110 allele had a higher BMI (27.3 kg/m2 +/- 3.9) compared with homozygotes for the common C-110 allele (26.3 kg/m2 +/- 3.3). The rarer homozygotes were shorter and heavier than the common homozygotes. A follow-up study involved 1431 healthy, middle aged men from the UK (NPHS II group). The frequency of the A-110 allele was 0.385 (95% CI = 0.37-0.40), and there was no association of genotype with BMI. Thus there appears to be no strong association of the Hsp70-1 promoter polymorphism with risk of myocardial infarction, BMI or any coronary disease traits analysed here. PMID:9553737

  10. Comparison of two-dimensional echocardiography with gated radionuclide ventriculography in the evaluation of global and regional left ventricular function in acute myocardial infarction

    International Nuclear Information System (INIS)

    Two-dimensional echocardiography and gated radionuclide ventriculography were performed in 93 patients (66 men, 27 women; mean age 61 years) with 95 episodes of acute myocardial infarction within 48 hours and at 10 days after infarction. Abnormal motion of an inferior or posterior wall segment was seen in 91% of inferoposterior infarctions by echocardiography versus 61% seen by radionuclide ventriculography. Ejection fractions determined by echocardiography and radionuclide ventriculography correlated well (r . 0.82) and did not change from the first 48 hours to 10 days after infarction (0.48 +/- 0.14). Similarly, wall motion score showed minimal change from the first 48 hours to 10 days. In-hospital mortality was 37 and 42% in patients with an ejection fraction of 0.35 or less by echocardiography and radionuclide ventriculography, respectively. No mortality was seen in patients with an ejection fraction above 0.40 by either test. The echocardiographic wall motion score was also predictive of mortality (40 versus 2%; score less than or equal to 0.50 versus greater than 0.50). The 1 year mortality rate in the 81 short-term survivors was 17%. Mortality was lowest in patients with an ejection fraction above 0.49 or wall motion score above (0.79 (2 to 5%) and worse in those with an ejection fraction below 0.36 or wall motion score below 0.51 (36 to 63%) by either technique. Thus in acute myocardial infarction, echocardiography and radionuclide ventriculography provide a c radionuclide ventriculography provide a comparable assessment of left ventricular function and wall motion in anterior infarction. Echocardiography appears more sensitive in detecting inferoposterior wall motion abnormalities. Both techniques are capable of identifying subgroups of patients with a high risk of death during the acute event and with an equally high mortality rate over a 1 year follow-up period

  11. Comparison of two-dimensional echocardiography with gated radionuclide ventriculography in the evaluation of global and regional left ventricular function in acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Van Reet, R.E.; Quinones, M.A.; Poliner, L.R.; Nelson, J.G.; Waggoner, A.D.; Kanon, D.; Lubetkin, S.J.; Pratt, C.M.; Winters, W.L. Jr.

    1984-02-01

    Two-dimensional echocardiography and gated radionuclide ventriculography were performed in 93 patients (66 men, 27 women; mean age 61 years) with 95 episodes of acute myocardial infarction within 48 hours and at 10 days after infarction. Abnormal motion of an inferior or posterior wall segment was seen in 91% of inferoposterior infarctions by echocardiography versus 61% seen by radionuclide ventriculography. Ejection fractions determined by echocardiography and radionuclide ventriculography correlated well (r . 0.82) and did not change from the first 48 hours to 10 days after infarction (0.48 +/- 0.14). Similarly, wall motion score showed minimal change from the first 48 hours to 10 days. In-hospital mortality was 37 and 42% in patients with an ejection fraction of 0.35 or less by echocardiography and radionuclide ventriculography, respectively. No mortality was seen in patients with an ejection fraction above 0.40 by either test. The echocardiographic wall motion score was also predictive of mortality (40 versus 2%; score less than or equal to 0.50 versus greater than 0.50). The 1 year mortality rate in the 81 short-term survivors was 17%. Mortality was lowest in patients with an ejection fraction above 0.49 or wall motion score above (0.79 (2 to 5%) and worse in those with an ejection fraction below 0.36 or wall motion score below 0.51 (36 to 63%) by either technique. Thus in acute myocardial infarction, echocardiography and radionuclide ventriculography provide a comparable assessment of left ventricular function and wall motion in anterior infarction. Echocardiography appears more sensitive in detecting inferoposterior wall motion abnormalities. Both techniques are capable of identifying subgroups of patients with a high risk of death during the acute event and with an equally high mortality rate over a 1 year follow-up period.

  12. SIGNIFICANCE OF FORREST CLASSIFICATION, ROCKALL’S AND BLATCHFORD’S RISK SCORING SYSTEM IN PREDICTION OF REBLEEDING IN PEPTIC ULCER DISEASE

    Directory of Open Access Journals (Sweden)

    Edvin Hadzibulic

    2007-12-01

    Full Text Available Prediction of the risk in patients with upper gastrointestinal bleeding has been the subject of different studies for several decades.This study showed the significance of Forrest classification, used in initial endoscopic investigation for evaluation of bleeding lesion, for the prediction of rebleeding.Rockall and Blatchford risk score systems evaluate certain clinical, biochemical and endoscopic variables significant for the prediction of rebleeding as well as the final outcome of disease.The percentage of rebleeding in the group of studied patients in accordance with Forrest classification showed that the largest number of patients belonged to the FIIb group. The predictive evaluation of initial and definitive Rockall score was significantly associated with percentage of rebleeding, while Blatchfor score had boundary significance.

  13. ¿Son aplicables las funciones SCORE y NCEP para el cálculo del riesgo cardiovascular en prevención primaria en la población argentina? / Can the SCORE and NCEP Function Charts be Applied in Primary Prevention to Estimate Cardiovascular Risk in the Argentine Population?

    Scientific Electronic Library Online (English)

    Silvia F, Benozzi; Cristina A, Álvarez; Guillermo, Gómez Echeverría; Fernando, Perruzza; Graciela L, Pennacchiotti.

    2010-08-01

    Full Text Available Introducción La estimación del riesgo cardiovascular en prevención primaria mediante ecuaciones elaboradas para tal fin permite optimizar la utilización de recursos disponibles en salud pública. Objetivos Evaluar el riesgo cardiovascular mediante la aplicación de las funciones SCORE y NCEP y analiza [...] r la concordancia entre ambas tablas en una población argentina. Material y métodos Se obtuvieron datos clínicos y bioquímicos de 234 personas adultas, de ambos sexos, que concurrieron al Servicio de Medicina Preventiva del Hospital Municipal de Bahía Blanca. Se definió el síndrome metabólico según criterios de la AHA y se determinó riesgo cardiovascular bajo según NCEP III Abstract in english Background The estimation of cardiovascular risk in primary prevention using equations specially developed for risk stratification allows optimizing the use of public health resources. Objectives To assess the cardiovascular risk using the SCORE and NCEP function charts and to analyze the agreement [...] between both charts in an Argentine population. Material and Methods We obtained clinical and biochemical data from 234 adult people of both genders who attended the Department of Preventive Medicine at the Hospital Municipal de Bahía Blanca. Metabolic syndrome was defined according to the AHA criteria and low cardiovascular risk was considered with NCEP III

  14. Scoring Subjectivity and Item Performance on Measures Used to Assess Violence Risk: The PCL-R and HCR-20 as Exemplars

    Science.gov (United States)

    Rufino, Katrina A.; Boccaccini, Marcus T.; Guy, Laura S.

    2011-01-01

    Although reliability is essential to validity, most research on violence risk assessment tools has paid little attention to strategies for improving rater agreement. The authors evaluated the degree to which perceived subjectivity in scoring guidelines for items from two measures--the Psychopathy Checklist-Revised (PCL-R) and the Historical,…

  15. Improvement of Predictive Value for Thromboembolic Risk by Incorporating Left Atrial Functional Parameters in the CHADS2 and CHA2DS2-VASc Scores.

    Science.gov (United States)

    Kim, Mi-Na; Kim, Su-A; Choi, Jong-Il; Park, Seoung-Mi; Park, Sang Won; Kim, Young Hoon; Shim, Wan Joo

    2015-05-13

    The discriminative ability of the widely used CHADS2 and CHA2DS2-VASc scores for risk stratification of thromboembolism in atrial fibrillation (AF) is known as modest. Some echocardiographic parameters are known risk factors for thromboembolism. This study aimed to evaluate whether combining echocardiographic parameters with CHADS2 and CHA2DS2-VASc scores can improve the predictive power for embolic risk in AF.A total of 526 (F/M = 83/433, mean age = 57.6 ± 10.7 years) patients with non-valvular AF were enrolled. The predictability for left atrial (LA) thrombus or dense spontaneous echo contrast (SEC) using clinical scores or echocardiographic parameters or combining clinical scores and echocardiographic parameters was calculated and compared.Dense SEC or thrombus was present in 51 patients. The predicting powers of the CHADS2 and CHADS2-VASc scores for the presence of dense SEC or thrombus were modest (c-statistics 0.65 and 0.68, respectively, 95% confidence interval [CI] 0.61-0.69 and 0.64-0.74, respectively, both P SEC among echocardiographic parameters. Combining impaired LA function (LA emptying fraction SEC or thrombus (c-statistics 0.78 and 95% CI 0.74-0.81 and c-statistics 0.77 and 95% CI 0.73-0.81, respectively, both P SEC. In clinical situations, anticoagulation should be considered to prevent embolism in patients with low-risk scores when they have LA dysfunction. PMID:25912904

  16. Changes over time in risk factors for cardiovascular disease and use of lipid-lowering drugs in HIV-infected individuals and impact on myocardial infarction

    DEFF Research Database (Denmark)

    no-lastname, no-firstname; Sabin, C A

    2008-01-01

    BACKGROUND: Because of the known relationship between exposure to combination antiretroviral therapy and cardiovascular disease (CVD), it has become increasingly important to intervene against risk of CVD in human immunodeficiency virus (HIV)-infected patients. We evaluated changes in risk factors for CVD and the use of lipid-lowering therapy in HIV-infected individuals and assessed the impact of any changes on the incidence of myocardial infarction. METHODS: The Data Collection on Adverse Events of Anti-HIV Drugs Study is a collaboration of 11 cohorts of HIV-infected patients that included follow-up for 33,389 HIV-infected patients from December 1999 through February 2006. RESULTS: The proportion of patients at high risk of CVD increased from 35.3% during 1999-2000 to 41.3% during 2005-2006. Of 28,985 patients, 2801 (9.7%) initiated lipid-lowering therapy; initiation of lipid-lowering therapy was more common for those with abnormal lipid values and those with traditional risk factors for CVD (male sex, older age, higher body mass index [calculated as the weight in kilograms divided by the square of the height in meters], family and personal history of CVD, and diabetes mellitus). After controlling for these, use of lipid-lowering drugs became relatively less common over time. The incidence of myocardial infarction (0.32 cases per 100 person-years [PY]; 95% confidence interval [CI], 0.29-0.35 cases per 100 PY) appeared to remain stable. However, after controlling for changes in risk factors for CVD, the rate decreased over time (relative rate in 2003 [compared with 1999-2000], 0.73 cases per 100 PY [95% CI, 0.50-1.05 cases per 100 PY]; in 2004, 0.64 cases per 100 PY [95% CI, 0.44-0.94 cases per 100 PY]; in 2005-2006, 0.36 cases per 100 PY [95% CI, 0.24-0.56 cases per 100 PY]). Further adjustment for lipid levels attenuated the relative rates towards unity (relative rate in 2003 [compared with 1999-2000], 1.06 cases per 100 PY [95% CI, 0.63-1.77 cases per 100 PY]; in 2004, 1.02 cases per 100 PY [95% CI, 0.61-1.71 cases per 100 PY]; in 2005-2006, 0.63 cases per 100 PY [95% CI, 0.36-1.09 cases per 100 PY]). CONCLUSIONS: Although the CVD risk profile among patients in the Data Collection on Adverse Events of Anti-HIV Drugs Study has decreased since 1999, rates have remained relatively stable, possibly as a result of a more aggressive approach towards managing the risk of CVD.

  17. Risk Score Estimation: a new method to determine optimal timing of aneurysm clipping for improved management outcome.

    Science.gov (United States)

    Duong, D H; Kolluri, V R; Spittaler, P J; Sengupta, R P

    1998-04-01

    The outcome of 703 patients who underwent surgery following aneurysmal subarachnoid hemorrhage were analyzed with regards to age, associated medical conditions, vasospasm and clinical status at the time of operation. Patients with Hunt and Hess grade I, II, and III had a 96%, 90% and 93% favorable (good and fair) outcome respectively. In contrast only 58% of patients with grade IV had the same result. The outcome was unfavorable in 13% of the patients who were older than 60 years of age and only in 9% of the patients between 30-59 years of age. All the patients younger than 30 years old had a good outcome. Associated medical condition increased the incidences of poor outcome (7% vs. 12%). Patients harboring vertebro basilar aneurysms had a poorer outcome, as opposed to those with aneurysms located in the anterior circulation (20% vs. 8%). The presence of angiographic vasospasm alone did not influence outcome. A proposed point value was given for each of the adverse factors and from this the optimal surgical time was determined for each individual patient. This concept of Risk Score Estimation approach may improve the management outcome of patients with ruptured intracranial aneurysms. PMID:9583582

  18. Cardiac sympathetic dysfunction contributes to left ventricular remodelling after acute myocardial infarction

    International Nuclear Information System (INIS)

    To investigate the role of the cardiac sympathetic nervous system in left ventricular remodelling, 50 patients with first-time acute myocardial infarction (AMI) and patency of the infarct-related artery after reperfusion underwent quantitative iodine-123 metaiodobenzylguanidine (MIBG) imaging at 4 days and 4 weeks (n=42), and quantitative technetium-99m tetrofosmin imaging at 2 days after AMI. They also underwent both ventriculography and coronary angiography on admission and about 4 weeks after AMI. On the basis of left ventricular end-systolic volume (LVESV), patients were divided into two groups. Patients with LVESV dilatation (n=20) had a significantly lower ejection fraction (P99mTc-tetrofosmin (P<0.04), and total severity (P<0.01), ? extent (P<0.007) and ? severity (P<0.0008) scores of MIBG than patients without LVESV dilatation (n=30). ? severity score of MIBG was directly correlated with change in LVESV at 4 weeks (r=0.63, P<0.0001). Stepwise linear discriminant function analysis showed that ? severity score of MIBG (P<0.0002) was the only discriminator of LVESV dilatation. Patients with LVESV dilatation had higher regional washout rates in both the infarct and the non-infarct zones than patients without such dilatation. Furthermore, no MIBG parameters changed significantly between 4 days and 4 weeks after AMI. In reperfused AMI, ? severity score of MIBG was related to the degree of ventriculas related to the degree of ventricular dilatation and was the only powerful discriminator of ventricular dilatation. These results suggest that cardiac sympathetic nervous abnormality might contribute to left ventricular remodelling in reperfused AMI. MIBG imaging may allow identification of reperfused AMI patients at high risk for left ventricular remodelling. (orig.)

  19. Primer puntaje de riesgo latinoamericano en cirugía cardíaca (ArgenSCORE): validación externa y temporal a 10 años de su desarrollo / External and Temporal Validation 10 Years after the Development of the First Latin- American Risk Stratification Score for Cardiac Surgery (ArgenSCORE)

    Scientific Electronic Library Online (English)

    Victorio C, Carosella; Hugo, Grancelli; Walter, Rodríguez; Miguel, Sellanes; Miguel, Cáceres; Hernán, Cohen Arazi; César, Cárdenas; Carlos, Nojek.

    2011-12-01

    Full Text Available Introducción En las últimas décadas se han aplicado diversos modelos de riesgo para predecir mortalidad en cirugía cardíaca, pero ninguno de estos sistemas de evaluación fue desarrollado en poblaciones de América Latina. Estos modelos presentan un rendimiento menor cuando son aplicados en poblacione [...] s diferentes de aquellas en las que fueron desarrollados. Objetivos Validar un modelo de riesgo local de mortalidad intrahospitalaria en cirugía cardíaca [Argentinean System for Cardiac Operative Risk Evaluation (ArgenSCORE)] en forma externa y temporal y compararlo con el EuroSCORE. Material y métodos Se incluyeron 5.268 pacientes adultos, consecutivos, intervenidos quirúrgicamente desde junio de 1994 hasta diciembre de 2009. El modelo fue desarrollado mediante regresión logística en 2.903 pacientes intervenidos en un centro desde junio de 1994 hasta diciembre de 1999. Se realizó validación interna prospectiva desde enero de 2000 hasta junio de 2001 en 708 pacientes. Desde febrero de 2000 hasta diciembre de 2009 se validó en forma externa y temporal el modelo recalibrado evaluando su discriminación y calibración en pacientes operados en cuatro centros diferentes del de su desarrollo y se comparó su rendimiento con el EuroSCORE. Resultados La población de validación externa incluyó 1.657 pacientes, con una edad media de 62,8 ± 13,3 años y una mortalidad global del 4,58%. El ArgenSCORE mostró un buen poder de discriminación (curva ROC: 0,80) y buena capacidad para asignar riesgo en todos los pacientes (relación mortalidad observada: 4,58% vs. mortalidad predicha: 4,54%; p = 0,842). El EuroSCORE mostró un buen poder discriminativo (curva ROC: 0,79), pero sobrevaloró el riesgo estimado (relación mortalidad observada: 4,58% vs. mortalidad predicha: 5,23%; p Abstract in english Background During the last decades, several risk assessment models have been applied to predict the risk of mortality after cardiac surgery; however, none of them have been developed in Latin American populations. These models have inferior performance when applied to patient groups other than the o [...] nes on whom they were developed. Objectives To perform external and temporal validation of a local risk score for cardiac surgery [Argentinean System for Cardiac Operative Risk Evaluation (ArgenSCORE)] and compare it to the EuroSCORE. Material and Methods A total of 5268 consecutive adult patients undergoing cardiac surgery were included from June 1994 to December 2009. The risk model was developed through logistic regression on the data of 2903 patients who underwent cardiac surgery between June 1994 and December 1999 at a center. Prospective internal validation was performed on 708 patients between January 2000 and June 2001. External and temporal validation of the recalibrated model were performed between February 2000 and December 2009, evaluating model discrimination and calibration in patients operated on at four centers different from the one where the score had been originally developed. The method was also compared to the EuroSCORE. Results The external validation was performed on 1657 patients, mean age was 62.8±13.3 years and global mortality was 4.58%. The ArgenSCORE showed both good discriminatory power with an area under the ROC curve of 0.80 and predictive capacity for risk assessment in all patients (observed mortality 4.58% vs. expected mortality 4.54%; p=0.842). The EuroSCORE showed good discriminatory power (area under the ROC curve of 0.79) but overestimated the risk (observed mortality 4.58% vs. expected mortality 5.23%; p

  20. Perfusion imaging with 99mTc PPN-1011 for the assessment of myocardial area at risk and the efficacy of PTCA/PTCR in myocardial infarction and unstable angina

    International Nuclear Information System (INIS)

    The determination of the myocardium at risk before intervention and the change in that region after intervention constitute a promising measurement tool for the assessment of acute therapy. We used 99mTc PPN-1011 (1,2-bis[bis(2-ethoxyethyl)phosphino]ethane) in 4 patients with acute myocardial ischemia (2 patients with acute myocardial infarction, 2 unstable angina) and subsequent successful reperfusion. All 4 patients had perfusion defect on the pre-reperfusion image. Perfusion abnormality on post-reperfusion image was all improved significantly compared with pre-reperfusion image, suggesting the efficacy of acute treatment in acute myocardial ischemia. We concluded that 99mTc PPN-1011 scintigraphy is a useful method for the assessment of myocardial area at risk and the efficacy of percutaneous transluminal coronary angioplasty (PTCA)/percutaneous transluminal coronary thrombolysis (PTCR) in myocardial infarction and unstable angina. (author)

  1. Early detection of the no-reflow phenomenon in reperfused acute myocardial infarction using technetium-99m tetrofosmin imaging

    International Nuclear Information System (INIS)

    Evaluation of myocardial perfusion in the early stage of acute myocardial infarction (MI) is clinically important for adjunctive therapies to minimize infarct size. To determine the role of early scintigraphic detection of impaired myocardial reperfusion after primary coronary angioplasty (PTCA) in patients with acute MI, semiquantitative technetium-99m tetrofosmin single-photon emission tomographic (SPET) imaging was performed before primary PTCA (before; area at risk), 60 min after PTCA (after) and at 1 month (1 M; final infarct) in 35 patients with acute MI. The left ventricle was divided into 13 segments and the defect score was calculated as the sum of the perfusion defect of each segment, from 3 (complete defect) to 0 (normal perfusion). A significant myocardial perfusion change after PTCA was defined as a change in the defect score (before minus after PTCA) of ?4. The echocardiographic asynergic score was defined as the number of asynergic (severe hypokinetic or akinetic) segments corresponding to the analogous segments on SPET images, and recovery of wall motion was calculated as absolute change in the asynergic score (before PTCA minus 1 M). Among the 35 patients, 15 (43%) had a change in the defect score of <4 (no reflow: group 1) while 20 had a change in the defect score of ?4 (reflow: group 2). There were no significant differences between the two groups with respect to the time between admission to PTCA, revascularization time, collateral grade or Thrrization time, collateral grade or Thrombolysis in Myocardial Infarction (TIMI) flow grade before PTCA. Despite the lack of a difference in area at risk between the two groups (group 1 = 12.8±4.3 and group 2 = 15.1±4.7), final infarct size in group 1 was significantly larger compared with that in group 2 (8.1±4.3 vs 4.9±3.0, P<0.001). Recovery of wall motion was significantly smaller in group 1 than in group 2 (4.3±1.7 to 3.5±1.5 vs 4.1±2.1 to 1.6±1.6, P<0.001). In conclusion, a small change (<4) in defect score (scintigraphic no-reflow phenomenon) after primary PTCA indicates persisting impaired myocardial perfusion or irreversible cellular damage just after PTCA which is associated with poor recovery of wall motion, as compared with that observed in cases of reflow (?4 in defect score). (orig.)

  2. Major life events increase the risk of stroke but not of myocardial infarction: results from the Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Kornerup, Henriette; Osler, Merete

    2010-01-01

    More attention has been paid to psychosocial conditions as possible risk factors for cardiovascular disease (CVD) and the impact of accumulated major life events (MLE) on the development of CVD has received little attention.

  3. The HAS-BLED Score Identifies Patients with Acute Venous Thromboembolism at High Risk of Major Bleeding Complications during the First Six Months of Anticoagulant Treatment

    Science.gov (United States)

    Kooiman, Judith; van Hagen, Nadja; Iglesias del Sol, Antonio; Planken, Erwin V.; Lip, Gregory Y. H.; van der Meer, Felix J. M.; Cannegieter, Suzanne C.; Klok, Frederikus A.; Huisman, Menno V.

    2015-01-01

    Objective The HAS-BLED score enables a risk estimate of major bleeds in patients with atrial fibrillation on vitamin K-antagonists (VKA) treatment, but has not been validated for patients with venous thromboembolism (VTE). We analyzed whether the HAS-BLED score accurately identifies patients at high risk of major bleeds during VKA treatment for acute VTE. Methods Medical records of 537 patients with acute VTE (primary diagnosis pulmonary embolism in 223, deep vein thrombosis in 314) starting VKA treatment between 2006-2007 were searched for items on the HAS-BLED score and the occurrence of major bleeds during the first 180 days of follow-up. The hazard ratio (HR) for the occurrence of major bleeds comparing non-high with high-risk patients as defined by a HAS-BLED score ? 3 points was calculated using Cox-regression analysis. Results Major bleeds occurred in 11/537 patients (2.0%, 5.2/100 person years, 95% CI 2.8-9.2). Cumulative incidences of major bleeds were 1.3% (95% CI 0.1-2.5) in the non-high (HAS-BLED < 3) and 9.6% (95%CI 2.2-17.0) in the high-risk group (HAS-BLED ? 3), (p <0.0001 by Log-Rank test), with a HR of 8.7 (95% CI 2.7-28.4). Of the items in the HAS-BLED score, abnormal renal function (HR 10.8, 95% CI 1.9-61.7) and a history of bleeding events (HR 10.4, 95% CI 2.5-42.5) were independent predictors of major bleeds during follow-up. Conclusion Acute VTE patients with a HAS-BLED score ? 3 points are at increased risk of major bleeding. These results warrant for correction of the potentially reversible risk factors for major bleeding and careful International Normalized Ratio monitoring in acute VTE patients with a high HAS-BLED score. PMID:25905638

  4. Radionuclide studies in the postmyocardial infarction patient

    International Nuclear Information System (INIS)

    Acute myocardial infarction is one of the most traumatic clinical expressions of coronary heart disease and is often the first manifestation of the disease that brings the patient to medical attention. Once the infarction has been recognized, acute care consists of pain relief, arrhythmia prophylaxis and treatment, hemodynamic assessment and stabilization, and in some settings, attempts at reestablishing flow through the occluded coronary artery responsible for the infraction. Once the patient has survived the initial 4- to 7- day period following the infarction, a new set of clinical issues become operative that have an important influence on long-term prognosis and management. This chapter focuses on how various nuclear medicine techniques can help identify myocardial infarction survivors at increased risk of reinfarction and sudden death. By so doing, these studies can help in the selection of appropriate further studies and in the selection of treatment which may help to favorably influence the subsequent natural history of the infarct survivor

  5. Risk of death or reinfarction associated with the use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs after acute myocardial infarction.

    DEFF Research Database (Denmark)

    Gislason, Gunnar H; Jacobsen, SØren

    2006-01-01

    BACKGROUND: The selective cyclooxygenase-2 (COX-2) inhibitors and other nonselective nonsteroidal antiinflammatory drugs (NSAIDs) have been associated with increased cardiovascular risk, but the risk in patients with established cardiovascular disease is unknown. We analyzed the risk of rehospitalization for acute myocardial infarction (MI) and death related to the use of NSAIDs including selective COX-2 inhibitors in patients with prior MI. METHODS AND RESULTS: All patients with first-time MI between 1995 and 2002 as well as all prescription claims for NSAIDs after discharge were identified from nationwide Danish administrative registers. The risk of death and rehospitalization for MI associated with the use of selective COX-2 inhibitors and nonselective NSAIDs was studied with the use of multivariable proportional hazards models and case-crossover analysis. A total of 58 432 patients were discharged alive and included in the study; 9773 experienced rehospitalization for MI, and 16 573 died. A total of 5.2% of patients received rofecoxib, 4.3% celecoxib, 17.5% ibuprofen, 10.6% diclofenac, and 12.7% other NSAIDs. For any use of rofecoxib, celecoxib, ibuprofen, diclofenac, and other NSAIDs, the hazard ratios and 95% confidence intervals for death were 2.80 (2.41 to 3.25; for rofecoxib), 2.57 (2.15 to 3.08; for celecoxib), 1.50 (1.36 to 1.67; for ibuprofen), 2.40 (2.09 to 2.80; for diclofenac), and 1.29 (1.16 to 1.43; for other NSAIDS); there were dose-related increases in risk of death for all of the drugs. There were trends for increased risk of rehospitalization for MI associated with the use of both the selective COX-2 inhibitors and the nonselective NSAIDs. CONCLUSIONS: Selective COX-2 inhibitors in all dosages and nonselective NSAIDs in high dosages increase mortality in patients with previous MI and should therefore be used with particular caution in these patients. Udgivelsesdato: 2006-Jun-27

  6. Genetic Risk Score of 46 Type 2 Diabetes Risk Variants Associates With Changes in Plasma Glucose and Estimates of Pancreatic beta-Cell Function Over 5 Years of Follow-Up

    DEFF Research Database (Denmark)

    Andersson, E. A.; Allin, K. H.

    2013-01-01

    More than 40 genetic risk variants for type 2 diabetes have been validated. We aimed to test whether a genetic risk score associates with the incidence of type 2 diabetes and with 5-year changes in glycemic traits and whether the effects were modulated by changes in BMI and lifestyle. The Inter99 study population was genotyped for 46 variants, and a genetic risk score was constructed. During a median follow-up of 11 years, 327 of 5,850 individuals developed diabetes. Physical examinations and oral glucose tolerance tests were performed at baseline and after 5 years (n = 3,727). The risk of incident type 2 diabetes was increased with a hazard ratio of 1.06 (95% CI 1.03-1.08) per risk allele. While the population in general had improved glucose regulation during the 5-year follow-up period, each additional allele in the genetic risk score was associated with a relative increase in fasting, 30-min, and 120-min plasma glucose values and a relative decrease in measures of -cell function over the 5-year period, whereas indices of insulin sensitivity were unaffected. The effect of the genetic risk score on 5-year changes in fasting plasma glucose was stronger in individuals who increased their BMI. In conclusion, a genetic risk score based on 46 variants associated strongly with incident type 2 diabetes and 5-year changes in plasma glucose and -cell function. Individuals who gain weight may be more susceptible to the cumulative impact of type 2 diabetes risk variants on fasting plasma glucose.

  7. Risk stratification and effects of percutaneous coronary intervention and the pharmacotherapy initiated in the first 24 hours on in-hospital mortality in patients with the first myocardial Infarction.

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Reissigová, Jindra; Tome?ková, Marie; Grünfeldová, H.; Janský, P.; Monhart, Z.; Vojá?ek, J.; Widimský, P.; Zvárová, Jana

    2011-01-01

    Ro?. 28, e-Supplement A (2011), e418. ISSN 0263-6352. [European Meeting on Hypertension and Cardiovascular Prevention /21./. 17.06.2011-20.06.2011, Milano] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : acute myocardial infarction * cardiovascular risk factors Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  8. Comparison of different screening tools (FRAX®, OST, ORAI, OSIRIS, SCORE and age alone) to identify women with increased risk of fracture. A population-based prospective study

    DEFF Research Database (Denmark)

    Rubin, Katrine Hass; Abrahamsen, Bo

    2013-01-01

    PURPOSE: To compare the power of FRAX® without bone mineral density (BMD) and simpler screening tools (OST, ORAI, OSIRIS, SCORE and age alone) in predicting fractures. METHODS: This study was a prospective, population-based study performed in Denmark comprising 3614 women aged 40-90years, who returned a questionnaire concerning items on risk factors for osteoporosis. Fracture risk was calculated using the different screening tools (FRAX®, OST, ORAI, OSIRIS and SCORE) for each woman. The women were followed using the Danish National Register registering new major osteoporotic fractures during 3years, counting only the first fracture per person. Area under the receiver operating characteristic curve (ROC) and statistics and Harrell's index were calculated. Agreement between the tools was calculated by kappa statistics. RESULTS: A total of 4% of the women experienced a new major osteoporotic fracture during the follow-up period. There were no differences in the area under the curve (AUC) values between FRAX® andthe simpler tools; AUC values between 0.703 and 0.722 (p=0.86). Also, Harrell's C values were very similar between the tools. Agreement between the tools was modest. CONCLUSION: During 3years follow-up FRAX® did not perform better in the fracture risk prediction compared with simpler tools such as OST, ORAI, OSIRIS, SCORE or age alone in a screening scenario where BMD was not measured. These findings suggest that simpler models based on fewer risk factors, which would be easier to use in clinical practice by the GP or the patient herself, could just as well as FRAX® be used to identify women with increased risk of fracture. SUMMARY: Comparison of FRAX® and simpler screening tools (OST, ORAI, OSIRIS, SCORE) in predicting fractures indicate that FRAX® did not perform better in fracture risk prediction compared with the simpler tools or even age alone in a screening scenario without bone mineral d