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A Novel Risk Stratification Model for Patients with Non-ST Elevation Myocardial Infarction in the Korea Acute Myocardial Infarction Registry (KAMIR): Limitation of the TIMI Risk Scoring System  

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The Thrombolysis in Myocardial Infarction (TIMI) risk score (TRS) has proven value in predicting prognosis in unstable angina/non ST-elevation myocardial infarction (NSTEMI) as well as in ST-elevation myocardial infarction. The TRS system has little implication, however, in the extent of myocardial damage in high-risk patients with NSTEMI. A total of 1621 patients (63.6±12.2 years; 1043 males) with NSTEMI were enrolled in the Korea Acute Myocardial Infarction Registry (KAMIR). We analyzed th...

Kim, Ju Han; Jeong, Myung Ho; Ahn, Youngkeun; Kim, Young Jo; Chae, Sung Chull; Seong, In Whan; Kim, Chong Jin; Cho, Myeong Chan; Seung, Ki Bae; Park, Seung Jung

2011-01-01

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

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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.

Charlot, Mette; Grove, Erik

2011-01-01

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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)

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

Charlot, Mette Gitz; Grove, Erik L

2011-01-01

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Escore TIMI no infarto agudo do miocárdio conforme níveis de estratificação de prognóstico Score TIMI en el infarto agudo de miocardio según niveles de estratificación de pronóstico TIMI risk score for acute myocardial infarction according to prognostic stratification  

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Full Text Available FUNDAMENTO: O escore de risco TIMI (thrombolysis in myocardial infarction é derivado de ensaio clínico envolvendo pacientes elegíveis para fibrinólise. Como o perfil de risco desses casos difere do encontrado em populações não selecionadas, é importante que se analise a aplicabilidade do escore em condições clínicas habituais. OBJETIVO: Avaliar o manejo e a evolução hospitalar de pacientes internados com infarto agudo do miocárdio conforme estratificação de risco pelo escore TIMI. MÉTODOS: Foram avaliados, retrospectivamente, 103 casos de infarto agudo do miocárdio com supradesnivelamento do segmento ST, admitidos no Hospital Nossa Senhora da Conceição, em Tubarão, nos anos de 2004 e 2005. Os casos foram analisados em três grupos de risco de acordo com o escore TIMI. RESULTADOS: A mortalidade hospitalar pós-infarto foi de 17,5%. No grupo de baixo risco não houve óbito. A mortalidade foi de 8,1% no grupo de médio risco e de 55,6% no de alto risco. O risco de morte para casos de alto risco foi 14,1 vezes maior em relação aos casos de médio e baixo risco (IC95% = 4,4 a 44,1 e pFUNDAMENTO: El score de riesgo TIMI (thrombolysis in myocardial infarction se derivó de ensayo clínico que implicó a pacientes elegibles para fibrinólisis. Como el perfil de riesgo de esos casos difiere del encontrado en poblaciones no seleccionadas, es importante que se analice la aplicabilidad del score en condiciones clínicas habituales. OBJETIVO: Evaluar el manejo y la evolución hospitalaria de pacientes internados con infarto agudo de miocardio de acuerdo con la estratificación de riesgo mediante la puntuación TIMI. MÉTODOS: Se evaluaron, retrospectivamente, 103 casos de infarto agudo de miocardio con supradesnivelamiento del segmento ST, ingresados en el Hospital Nossa Senhora da Conceição, en Tubarão, en los años de 2004 y 2005. Se analizaron los casos en tres grupos de riesgo según el score TIMI. RESULTADOS: La mortalidad hospitalaria postinfarto fue de un 17,5%. En el grupo de bajo riesgo no hubo óbito. La mortalidad fue del 8,1% en el grupo de medio riesgo y de un 55,6% en el de alto riesgo. El riesgo de muerte para casos de alto riesgo fue 14,1 veces mayor con relación a los casos de medio y bajo riesgo (IC95% = 4,4 a 44,1 y pBACKGROUND: The TIMI (Thrombolysis in Myocardial Infarction risk score is derived from clinical trial involving patients who are eligible for fibrinolysis. As the risk profiles of these cases differ from those found in non-selected populations, it is important to review the applicability of the score in usual clinical conditions. OBJECTIVES: To evaluate the management and clinical evolution of hospital inpatients with acute myocardial infarction, according to risk stratification by the TIMI score. METHODS: We evaluated, retrospectively, 103 cases of acute myocardial infarction with ST-segment elevation admitted to the Hospital Nossa Senhora da Conceição - Tubarão, in 2004 and 2005. The cases were analyzed in three risk groups according to the TIMI score. RESULTS: The hospital mortality after infarction was 17.5%. In the low-risk group there was no death. The mortality was 8.1% in the medium risk group and 55.6% in the high-risk group. The risk of death in cases of high risk was 14.1 times higher than in the cases of medium and low risk (95% CI = 4.4 to 44.1 and p <0.001. The chance of receiving fibrinolytic was 50% lower in the high-risk group in relation to the low risk group (95% CI = 0.27 to 0.85, p = 0.004. CONCLUSION: There was a progressive increase in mortality and incidence of in-hospital complications according to the stratification by the TIMI score. High risk patients received thrombolytic less frequently than the patients at low risk.

Jaqueline Locks Pereira

2009-08-01

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Lower Framingham risk score and the absence of hypertension are associated with the morning peak in the circadian variation of ST-elevation myocardial infarction onset.  

Science.gov (United States)

There are few studies analyzing the influences of coronary risk factors on the circadian variation of ST-elevation myocardial infarction (STEMI). Between 2008 and 2011, 293 patients were admitted to Miyazaki Prefectural Nobeoka Hospital with STEMI. The onset time of STEMI was identified in 280 patients (age, 70.5±11.7 years; male subjects, 68%; hypertension (HT), 80%; diabetes mellitus, 28%; current smoking (cSM), 33%; Framingham risk score (FRS), 8.77±3.28). The day was divided into six 4-h periods, with the morning peak between 0800 and 1200 hours. The frequency of HT was significantly lower in the morning incidence group than in the nighttime incidence group. Multivariate logistic regression analysis revealed that the prevalence of HT was the only independent variable associated with the morning peak of STEMI (odds ratio (OR), 0.43; 95% confidence interval (95% CI), 0.23-0.83; P=0.01) and that cSM was significantly associated with the nighttime peak of STEMI (OR, 1.96; 95% CI, 1.01-3.80; P=0.04). A comprehensive evaluation using the FRS showed that the FRS was significantly lower in the morning incidence group than in the nighttime incidence group and the other time incidence group (7.95±3.47 vs. 9.14±2.89 vs. 9.06±3.25, PFRS was associated with the morning peak of STEMI (OR, 1.12; 95% CI, 1.02-1.21; P=0.01). A lower FRS and non-HT status are associated with the morning peak in the circadian variation of STEMI onset. The morning incidence of STEMI might be affected by pathogenic factors other than the classic coronary risk factors. PMID:24108239

Usuku, Hiroki; Izumiya, Yasuhiro; Sugiyama, Seigo; Kojima, Sunao; Araki, Satoshi; Kurogi, Kazumasa; Yamamoto, Nobuyasu; Ando, Yukio; Ogawa, Hisao

2014-03-01

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

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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.

Carlsen, Esben A; Bang, Lia E

2012-01-01

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

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Summary 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.

Voight, Benjamin F; Peloso, Gina M; Orho-Melander, Marju; Frikke-Schmidt, Ruth; Barbalic, Maja; Jensen, Majken K; Hindy, George; Holm, Hilma; Ding, Eric L; Johnson, Toby; Schunkert, Heribert; Samani, Nilesh J; Clarke, Robert; Hopewell, Jemma C; Thompson, John F; Li, Mingyao; Thorleifsson, Gudmar; Newton-Cheh, Christopher; Musunuru, Kiran; Pirruccello, James P; Saleheen, Danish; Chen, Li; Stewart, Alexandre FR; Schillert, Arne; Thorsteinsdottir, Unnur; Thorgeirsson, Gudmundur; Anand, Sonia; Engert, James C; Morgan, Thomas; Spertus, John; Stoll, Monika; Berger, Klaus; Martinelli, Nicola; Girelli, Domenico; McKeown, Pascal P; Patterson, Christopher C; Epstein, Stephen E; Devaney, Joseph; Burnett, Mary-Susan; Mooser, Vincent; Ripatti, Samuli; Surakka, Ida; Nieminen, Markku S; Sinisalo, Juha; Lokki, Marja-Liisa; Perola, Markus; Havulinna, Aki; de Faire, Ulf; Gigante, Bruna; Ingelsson, Erik; Zeller, Tanja; Wild, Philipp; de Bakker, Paul I W; Klungel, Olaf H; Maitland-van der Zee, Anke-Hilse; Peters, Bas J M; de Boer, Anthonius; Grobbee, Diederick E; Kamphuisen, Pieter W; Deneer, Vera H M; Elbers, Clara C; Onland-Moret, N Charlotte; Hofker, Marten H; Wijmenga, Cisca; Verschuren, WM Monique; Boer, Jolanda MA; van der Schouw, Yvonne T; Rasheed, Asif; Frossard, Philippe; Demissie, Serkalem; Willer, Cristen; Do, Ron; Ordovas, Jose M; Abecasis, Goncalo R; Boehnke, Michael; Mohlke, Karen L; Daly, Mark J; Guiducci, Candace; Burtt, Noel P; Surti, Aarti; Gonzalez, Elena; Purcell, Shaun; Gabriel, Stacey; Marrugat, Jaume; Peden, John; Erdmann, Jeanette; Diemert, Patrick; Willenborg, Christina; Konig, Inke R; Fischer, Marcus; Hengstenberg, Christian; Ziegler, Andreas; Buysschaert, Ian; Lambrechts, Diether; Van de Werf, Frans; Fox, Keith A; El Mokhtari, Nour Eddine; Rubin, Diana; Schrezenmeir, Jurgen; Schreiber, Stefan; Schafer, Arne; Danesh, John; Blankenberg, Stefan; Roberts, Robert; McPherson, Ruth; Watkins, Hugh; Hall, Alistair S; Overvad, Kim; Rimm, Eric; Boerwinkle, Eric; Tybjaerg-Hansen, Anne; Cupples, L Adrienne; Reilly, Muredach P; Melander, Olle; Mannucci, Pier M; Ardissino, Diego; Siscovick, David; Elosua, Roberto; Stefansson, Kari; O'Donnell, Christopher J; Salomaa, Veikko; Rader, Daniel J; Peltonen, Leena; Schwartz, Stephen M; Altshuler, David; Kathiresan, Sekar

2012-01-01

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A QRS scoring system for assessing left ventricular function and myocardial infarct size  

International Nuclear Information System (INIS)

Left ventricular function and infarct size were evaluated noninvasively by 12 lead electrocardiography (ECG), Tl-201 imaging (TLI) and ECG gated radionuclide ventriculography (RNV) examined from 5 to 14 days after the initial attack in 36 patients with acute transmural myocardial infarction. Ages ranged from 32 to 77 years with a mean of 60. The subjects were divided into 2 groups according to the site of infarct: anterior and inferior. Parameters obtained were left ventricular ejection fraction (EF) examined by RNV, QRS score described by Palmeri et al. total myocardial perfusion index (TMPI), lung uptake of Tl-201 (LU) on TLI. Significant negative correlation was obtained between EF and QRS score (r = -0.784, p < 0.01), better in patients with inferior MI than those with anterior. Also significant relationship was noted between TMPI and QRS score (r = 0.636, p < 0.01). LU had a specificity of 93 % and a sensitivity of 71 % for predicting EF < 30 % and 79 % and 86 % respectively for TMPI < 30. These data suggest that left ventricular function and infarct size will be detected by QRS score. LU was thought to be a fairly good sign predicting decreased EF (< 30 %) and massive infarct. (author)

1985-01-01

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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  

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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

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

2008-01-01

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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.)

2006-12-01

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Summary Variables in Observational Research: Propensity Scores and Disease Risk Scores.  

Science.gov (United States)

This paper describes the use of two types of summary scores in the context of observational research in pharmaco-epidemiology: propensity scores and disease risk scores. Either of these approaches collapses multiple potentially confounding variables into ...

J. D. Seeger P. G. Arbogast

2012-01-01

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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 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)

1995-10-01

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Leukocytosis: a risk factor for myocardial infarction  

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Full Text Available Suman K KotlaDepartment of Internal Medicine, Memorial Medical Center, Johnstown, PA, USAAbstract: Myocardial infarction commonly results from atherosclerotic lesions in the coronary arteries. Approximately 5% of patients with acute myocardial infarction do not have atherosclerotic disease. In this case report, we present an unusual leukostatic complication in a patient with acute myeloblastic leukemia and extreme hyperleukocytosis who presented with an acute myocardial infarction that resolved after leukopheresis. Myocardial infarction as the initial presentation of acute leukemia has been reported only rarely.Keywords: leukocytosis, myocardial infarction, leukostasis

Kotla SK

2012-05-01

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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)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese 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.

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

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

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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

Scruth E

2013-08-01

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Clinical discriminators between acute brain hemorrhage and infarction: a practical score for early patient identification  

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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 <= 2, with sensitivity of 76% and specificity of 83%. External validation was done using the NOMASS cohort. Although the use of a practical score by emergency personnel cannot replace the gold-standard brain image differentiation of HEM from INF for thrombolytic therapy, this score can help to select patients for stroke trials and pre-hospital treatments, alert CT scan technicians, and warn stroke teams of incoming patients to reduce treatment delays.

Massaro Ayrton R.

2002-01-01

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Heart rate turbulence as risk-predictor after myocardial infarction  

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Full Text Available Heart Rate Turbulence (HRT is the baroreflex-mediated short-term oscillation of cardiac cycle lengths after spontaneous ventricular premature complexes (VPC. HRT is composed of a brief heart rate acceleration followed by a gradual heart rate deceleration. In high risk patients after myocardial infarction (MI HRT is blunted or diminished. Since its first description in 1999 HRT emerged as one of the most potent risk factors after MI. Predictive power of HRT has been studied in more than 10,000 post-infarction patients. This review is intended to provide an overview of HRT as risk predictor after MI.

ChristineStefanieZuern

2011-12-01

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Left ventricular asynergy score as an indicator of previous myocardial infarction  

International Nuclear Information System (INIS)

Sixty-eight patients with coronary heart disease (CHD) i.e. a hisotry of angina of effort and/or previous 'possible infarction' were examined inter alia with ECG and cinecardioangiography. A system of scoring was designed which allowed a semiquantitative estimate of the left ventricular asynergy from cinecardioangiography - the left ventricular motion score (LVMS). The LVMS was associated with the presence of a previous myocardial infarction (MI), as indicated by the history and ECG findings. The ECG changes specific for a previous MI were associated with high LVMS values and unspecific or absent ECG changes with low LVMS values. Decision thresholds for ECG changes and asynergy in diagnosing a previous MI were evaluated by means of a ROC analysis. The accuracy of ECG in detecting a previous MI was slightly higher when asynergy indicated a 'true MI' than when autopsy result did so in a comparable group. Therefore the accuracy of asynergy (LVMS ? 1) in detecting a previous MI or myocardial fibrosis in patients with CHD should be at least comparable with that of autopsy (scar > 1 cm). (orig.)

1986-01-01

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Limitations of a QRS scoring system to assess left ventricular function and prognosis at hospital discharge after myocardial infarction.  

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The value of a QRS scoring system derived from 12 lead electrocardiograms to estimate left ventricular ejection fraction was assessed in a prospective study of 285 hospital survivors of myocardial infarction. In these patients both the QRS score and ejection fraction were measured by radionuclide ventriculography at discharge. The correlation between ejection fraction and QRS score was weak. In 22 patients who died during six to 12 months follow up the ability of the ejection fraction and QRS...

Fioretti, P.; Brower, R. W.; Lazzeroni, E.; Simoons, M. L.; Wijns, W.; Reiber, J. H.; Bos, R. J.; Hugenholtz, P. G.

1985-01-01

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The relationship of montreal cognitive assessment scores to framingham coronary and stroke risk scores  

Directory of Open Access Journals (Sweden)

Full Text Available We examined the relationship between a brief cognitive screening measure and Framingham Coronary and Stroke Risk scores. We administered the Montreal Cognitive Assessment (MoCA to participants in the Dallas Heart Study, a community-based multiethnic study investigating the development of atherosclerosis. The composition of the group was 50% African American, 36% Caucasian and 14% Hispanic. There were 765 subjects (mean age 51 years who had both Coronary and Stroke Risk scores and an additional 144 subjects with only Coronary Risk scores available. There was a small significant inverse relationship between MoCA and Framingham Coronary and Stroke Risk scores. MoCA scores were influenced by education, but were not influenced by age or by the presence of one or more apoE4 alleles.

Myron Frederick Weiner

2011-07-01

 
 
 
 
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Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis  

Science.gov (United States)

Background The Thrombolysis in Myocardial Infarction (TIMI) risk score uses clinical data to predict the short-term risk of acute myocardial infarction, coronary revascularization or death from any cause. It was originally developed for use in patients with unstable angina or non–ST-elevation myocardial infarction. We sought to expand the clinical application of the TIMI risk score by assessing its prognostic accuracy in patients in the emergency department with potential acute coronary syndromes. Methods We searched five electronic databases, hand-searched reference lists of included studies and contacted content experts to identify articles for review. We included prospective cohort studies that validated the TIMI risk score in emergency department patients. We performed a meta-regression to determine whether a linear relation exists between TIMI risk score and the cumulative incidence of cardiac events. Results We included 10 prospective cohort studies (with a total of 17 265 patients) in our systematic review. Data were available for meta-analysis in 8 of the 10 studies. Of patients with a score of zero, 1.8% had a cardiac event within 30 days (sensitivity 97.2%, 95% CI 96.4–97.8; specificity 25.0%, 95% CI 24.3–25.7; positive likelihood ratio 1.30, 95% CI 1.28–1.31; negative likelihood ratio 0.11, 95% CI 0.09–0.15). Meta-regression analysis revealed a strong linear relation between TIMI risk score (p < 0.001) and the cumulative incidence of cardiac events. Interpretation Although the TIMI risk score is an effective risk stratification tool for patients in the emergency department with potential acute coronary syndromes, it should not be used as the sole means of determining patient disposition.

Hess, Erik P.; Agarwal, Dipti; Chandra, Subhash; Murad, Mohammed H.; Erwin, Patricia J.; Hollander, Judd E.; Montori, Victor M.; Stiell, Ian G.

2010-01-01

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The Role of Unknown Risk Factors in Myocardial Infarction  

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Full Text Available Objectives: To evaluate risk factors in myocardial infarction like age, sex, smoking, diabetes mellitus, hyperlipidemia, hypertension, positive family history, high level of cholesterol, stress and poor physical activity.Methods: This is a retrospective study on 163 myocardial infarction cases, conducted in the cardiology ward and CCU at a General Public Hospital, Baroda. A number of risk factors identified and evaluated in these patients included: hyperlipidemia, hypertension, diabetes mellitus, smoking, physical activity, stress, age, and sex.  Results: The majority of our patients were old men in the age range of 60 - 69 years. Amongst all patients 36.7% were smokers, 61.3% were type A personality group, 18.5% were active, 81.5% were physically inactive, 28.9% had hypertension, 23.3% were diabetic, 17.5% had hyperlipidemia and 33.2% had positive family history of myocardial infarction.Conclusions: In regard of increasing rate of cardiovascular diseases and myocardial infarction even amongst the young population, and because of considerable need to improve vascular risk detection, much research over the past decade has focused on identification of novel atherosclerotic risk factors, and some of these new risk factors are identified and some may be unknown. Amongst the new risk factors, inflammation has an important role, other risk factors that must be assessed are homocysteine, serum amyloid. So we recommend that governments and heart associations must introduce new plans and policies in order to tackle the problem and reduce the frequency of cardiovascular disease. This requires the understanding of the conventional or classic risk factors and also the less known and new risk factors and ways which they may be prevented. 

Nita A Tanna

2013-07-01

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

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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.

Lorenzo-Aguiar Dolores

2011-01-01

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Heart Rate Turbulence as Risk-Predictor after Myocardial Infarction  

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Heart rate turbulence (HRT) is the baroreflex-mediated short-term oscillation of cardiac cycle lengths after spontaneous ventricular premature complexes. HRT is composed of a brief heart rate acceleration followed by a gradual heart rate deceleration. In high risk patients after myocardial infarction (MI) HRT is blunted or diminished. Since its first description in 1999 HRT emerged as one of the most potent risk factors after MI. Predictive power of HRT has been studied in more than 10,000 po...

Zuern, Christine S.; Barthel, Petra; Bauer, Axel

2011-01-01

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

Simona Giampaoli; Luigi Palmieri; Chiara Donfrancesco; Salvatore Panico; Diego Vanuzzo; Lorenza Pilotto; Marco Ferrario; Giancarlo Cesana; Amalia Mattiello; Cuore, The Project Research Group

2007-01-01

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

Directory of Open Access Journals (Sweden)

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.

Simona Giampaoli

2007-06-01

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Risk Factors And Seasonal-Diurinal Variatons In Lacunar Infarctions  

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Full Text Available Lacunar infarctions are deeply located ischemic infarctions smaller than 1.5 cm in diameter. Patients hospitalized in our neurology clinic in between 2001 and 2005 with signs of lacunar infarction and in whom diagnosis were confirmed with neuroimaging studies, were included in this study. Risk factors and time of symptom-onset were re-evaluated by use of phone calls with them and/or their relatives. Eighty-one patients with mean age of 64.6 were involved in the study. Forty-three of them (%53 were female. The lesion was in left hemisphere in forty-five patients (%55.6, and in right hemisphere in remaining 36 (%44.4 ones. There was at least one vascular risk factor in 80 of them (%98.8, and a cardiac one in 6 patients (%7.4. Sixty-five patients (%80.2 had multiple vascular risk factors. There was hypertension in 68 (%83.9, dyslipidemia in 48 (%59.2, smoking in 26 (%32.1, and diabetes mellitus in 22 (%27.2 of them. Among 16 patients with single risk factor, 10 patients had hypertension and 6 patients had dyslipidemia. In 34 of them (%41.9, symptoms had appeared during night-time (sleeping + first hour of awakeness, and in 47 of them (%58.1 during day-time. The disease was seen during winter in 17 (21%, spring in 22 (27.2%, summer in 19 (23.4%, and autumn in 23 (28.3% of them. After analyses were corrected according to risk factors, sex and age, any seasonal-diurnal variation or side differences were not detected. Presence of many patients with single risk factor reveals the importance of primary prophylaxis clearly. High frequency of multiple risk factors underlines needs for use of preventive treatment carefully in these patients.

Murat ALEMDAR

2006-06-01

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TIMI, GRACE and alternative risk scores in Acute Coronary Syndromes: A meta-analysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients.  

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BACKGROUND: Acute coronary syndromes (ACS) represent a difficult challenge for physicians. Risk scores have become the cornerstone in clinical and interventional decision making. METHODS AND RESULTS: PubMed was systematically searched for ACS risk score studies. They were divided into ACS studies (evaluating Unstable Angina; UA, Non ST Segment Elevation Myocardial Infarction; NSTEMI, and ST Segment Elevation Myocardial Infarction; STEMI), UA/NSTEMI studies or STEMI studies. The c-s...

Gaita, Fiorenzo; D Ascenzo, Fabrizio; Presutti, Davide Giacomo

2012-01-01

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Comparison of different electrocardiographic scoring systems for detection of any previous myocardial infarction as assessed with cardiovascular magnetic resonance imaging.  

Science.gov (United States)

Although electrocardiography is frequently used as an initial test to detect or rule out previous myocardial infarction (MI), the diagnostic performance of commonly used electrocardiographic scoring systems is not well described. We aimed to determine the diagnostic accuracy of (1) the Universal Definition, (2) Minnesota ECG Code (MC), (3) Selvester QRS Score, and (4) assessment by cardiologists using late gadolinium enhancement cardiovascular magnetic resonance imaging as the reference standard. Additionally, the effect of electrocardiographic patterns and infarct characteristics on detecting previous MI was evaluated. The 3-month follow-up electrocardiograms of 78 patients with first-time reperfused ST elevation MI were pooled with electrocardiograms of 36 healthy controls. All 114 electrocardiograms were randomly analyzed, blinded to clinical and LGE-CMR data. The sensitivity of the Universal Definition, MC, Selvester QRS Score, and cardiologists to detect previous MI was 33%, 79%, 90%, and 67%, respectively; specificity 97%, 72%, 31%, and 89%, respectively; diagnostic accuracy 54%, 77%, 71%, and 74%, respectively. Probability of detecting MI by cardiologists increased with an increasing number (odds ratio [OR] 2.00, 95% confidence interval [CI] 1.30 to 3.09), width (OR 1.02, 95% CI 1.01 to 1.03), and depth (OR 1.16, 95% CI 1.07 to 1.27) of Q waves as well as increasing infarct size (OR 1.15, 95% CI 1.06 to 1.25) and transmurality (OR 1.05, 95% CI 1.01 to 1.08; p Q waves as well as increasing infarct size and transmurality. In conclusion, the exclusion of a previous MI based solely on electrocardiographic findings should be done with caution. Future studies are needed to define which patients should be referred to additional diagnostic testing. PMID:23827406

Jaarsma, Caroline; Bekkers, Sebastiaan C; Haidari, Zaki; Smulders, Martijn W; Nelemans, Patricia J; Gorgels, Anton P; Crijns, Harry J; Wildberger, Joachim E; Schalla, Simon

2013-10-15

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High-risk subgroup of inferior myocardial infarction  

International Nuclear Information System (INIS)

To identify high-risk subgroups of inferior myocardial infarction, 75 patients presenting with their first inferior infarction were investigated by sequential gated blood pool scans. The patients were divided into four groups based on the right ventricular function (RVF) and anterior wall motion (AWM) of the left ventricle by scan at the time of admission. A second blood pool scan was performed at ten days to evaluate RV and LV function. Thirty-eight patients had cardiac catheterization before discharge and all patients were followed up for one year to determine their clinical outcome. Depressed RVF and reduced AWM were observed in 26 (35 %) (Group A); depressed RVF and normal AWM were found in 20 (27 %) (Group B); reduced AWM and normal RVE in 10 (13 %) (Group C); and normal RVF and AWM in 19 (25 %) (Group D). The mean values of biventricular function (LVEF, RVEF) in groups A, B, C, and D were (44.9 ± 8.4 %, 32.5 ± 9.9 %), (59.9 ± 8.6 %, 34.5 ± 8.0 %), (44.9 ± 15.7 %, 48.2 ± 3.3 %), and (60.4 ± 9.1 %, 51.6 ± 10.6%), respectively, at admission. In serial measurements, LVEF did not change significantly in any group, however, RVEF improved nearly 10 points in groups A and B at 10 days. Group A also had the highest incidence (82 %) of left anterior descending coronary artery involvement, and the highest mean creatine phosphokinase levels (762 ± 318 U/1): Furthermore, group A had a high incidence of major complications during their hospital course and high mortality during the one-year follow-up. These data clearly identified group A as a high-risk subgroup of patients with inferior infarction. (author)

1986-01-01

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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)

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).

Munk, Kim; Andersen, Niels Holmark

2012-01-01

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Time course of lesion development in patients with acute brain stem infarction and correlation with NIHSS score  

International Nuclear Information System (INIS)

Background and purpose: diffusion weighted magnetic resonance imaging (MRI) is highly sensitive in detecting acute supratentorial cerebral ischemia and Diffusion Weighted Imaging (DWI) lesion size has been shown to correlate strongly with the neurologic deficit in middle cerebral artery territory stroke. However, data concerning infratentorial strokes are rare. We examined the size and evolution of acute brain stem ischemic lesions and their relationship to neurological outcome. Methods: brain stem infarctions of 11 patients were analyzed. We performed DWI in all patients and in 7/11 patients within 24 h, T2W sequences within the first 2 weeks (10/11 patients) and follow-up MRI (MR2) within 3-9 months (median 4.8 months) later (12/12 patients). Lesion volumes were compared with early and follow-up neurologic deficit as determined by National Institutes of Health Stroke Scale (NIHSS) score. Results: the relative infarct volumes--with MR2 lesion size set to 100%--decreased over the time (P<0.02) with a mean shrinking factor of 3.3 between DWI (MR0) and the follow-up MRT (P<0.02), and 1.6 between early T2W (MR1) and MR2 (P<0.04). The mean DWI volume size (MR0) was larger than the early T2W (P<0.02). Although neurological outcome was good in all patients (mean NIHSS score of 1.3 at follow-up), early NIHSS and follow-up NIHSS scores were strongly correlated (r=0.9, P<0.00). NIHSS score at follow-up was highly correlated with lesion size of DWI (MR0; r=0.71, P<0.04) and T2W of MR1 (r=0.86, P<0.001). Conclusions: in this study, we saw a shrinking of the brain stem infarct volume according to clinical improvement of patients. Great extension of restricted diffusion in the acute stage does not necessarily implicate a large resulting infarction or a bad clinical outcome

2001-09-01

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

DEFF Research Database (Denmark)

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.

Horsdal, Henriette Thisted; Søndergaard, Flemming

2011-01-01

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Feasibility of an automated quantitative computed tomography angiography-derived risk score for risk stratification of patients with suspected coronary artery disease.  

Science.gov (United States)

Coronary computed tomography angiography (CTA) has important prognostic value. Additionally, quantitative CTA (QCT) provides a more detailed accurate assessment of coronary artery disease (CAD) on CTA. Potentially, a risk score incorporating all quantitative stenosis parameters allows accurate risk stratification. Therefore, the purpose of this study was to determine if an automatic quantitative assessment of CAD using QCT combined into a CTA risk score allows risk stratification of patients. In 300 patients, QCT was performed to automatically detect and quantify all lesions in the coronary tree. Using QCT, a novel CTA risk score was calculated based on plaque extent, severity, composition, and location on a segment basis. During follow-up, the composite end point of all-cause mortality, revascularization, and nonfatal infarction was recorded. In total, 10% of patients experienced an event during a median follow-up of 2.14 years. The CTA risk score was significantly higher in patients with an event (12.5 [interquartile range 8.6 to 16.4] vs 1.7 [interquartile range 0 to 8.4], p <0.001). In 127 patients with obstructive CAD (?50% stenosis), 27 events were recorded, all in patients with a high CTA risk score. In conclusion, the present study demonstrated that a fully automatic QCT analysis of CAD is feasible and can be applied for risk stratification of patients with suspected CAD. Furthermore, a novel CTA risk score incorporating location, severity, and composition of coronary lesion was developed. This score may improve risk stratification but needs to be confirmed in larger studies. PMID:24798123

de Graaf, Michiel A; Broersen, Alexander; Ahmed, Wehab; Kitslaar, Pieter H; Dijkstra, Jouke; Kroft, Lucia J; Delgado, Victoria; Bax, Jeroen J; Reiber, Johan H C; Scholte, Arthur J

2014-06-15

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

DEFF Research Database (Denmark)

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

Diederichsen, Axel Cosmus Pyndt; Sand, Niels Peter

2012-01-01

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Reliability and validity of the postepidural fall risk assessment score.  

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The purpose of this study was to establish the interrater reliability and face validity of the postepidural fall risk assessment score instrument for the obstetric patient. The sample consisted of 207 healthy mothers at an inner-city level 1 trauma center. Kappa coefficients ranged from 0.54 to 0.83. Face validity of the tool was determined by participating nurses (n = 25). Results indicated that the tool was reliable and required modification to increase face validity. PMID:24375109

Thompson, Kathleen; Haddad, Lisa; Smith, Sarah

2014-01-01

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Increased risk of myocardial infarction with dabigatran: fact or fiction?  

Science.gov (United States)

Dabigatran is a direct, competitive inhibitor of thrombin recently approved for the prophylaxis of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. In some of the clinical trials evaluating the efficacy and safety of dabigatran in different clinical settings [i.e., prevention of venous thromboembolism (VTE) after orthopedic surgery, secondary prevention of VTE, and acute coronary syndromes (ACS)], a trend toward an increase in acute coronary events among patients receiving dabigatran has been reported, thus raising concerns of a possible relationship between dabigatran and myocardial infarction, especially in high-risk patients. However, as shown in our article, current evidence is inconclusive on this topic; more data are needed to detail this hypothetical association, and other considerations, such as the well-known protective effect of warfarin against ACS, should be taken into account as a possible explanation. PMID:24492353

Giglio, Ada F; Basile, Eloisa; Santangeli, Pasquale; Di Biase, Luigi; Trotta, Francesco; Natale, Andrea

2014-01-01

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Alcohol Intake, Myocardial Infarction, Biochemical Risk Factors, and Alcohol Dehydrogenase Genotypes  

DEFF Research Database (Denmark)

  Background- The risk of myocardial infarction is lower among light-to-moderate alcohol drinkers compared with abstainers. We tested associations between alcohol intake and risk of myocardial infarction and risk factors and whether these associations are modified by variations in alcohol dehydrogenases. Methods and Results- We used information on 9584 men and women from the Danish general population in the Copenhagen City Heart Study. During follow-up, from 1991 to 2007, 663 incident cases of myocardial infarction occurred. We observed that increasing alcohol intake was associated with decreasing risk of myocardial infarction, decreasing low-density lipoprotein cholesterol and fibrinogen, increasing diastolic and systolic blood pressure and high-density lipoprotein cholesterol, and with U-shaped nonfasting triglycerides. In contrast, ADH1B and ADH1C genotypes were not associated with risk of myocardial infarction or with any of the cardiovascular biochemical risk factors, and there was no indication that associations between alcohol intake and myocardial infarction and between alcohol intake and risk factors were modified by genotypes. Conclusions- Increasing alcohol intake is associated with decreasing risk of myocardial infarction, decreasing low-density lipoprotein cholesterol and fibrinogen, increasing diastolic and systolic blood pressure and high-density lipoprotein cholesterol, and U-shaped nonfasting triglycerides. These associations were not modified by ADH1B and ADH1C are genotypes. Udgivelsesdato: 2009

Tolstrup, Janne Schurmann; Grønbæk, Morten

2009-01-01

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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)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese 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.

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

2014-07-15

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A dynamic risk score to identify increased risk for heart failure decompensation.  

Science.gov (United States)

A method for combining heart failure (HF) diagnostic information in a Bayesian belief network (BBN) framework to improve the ability to identify when patients are at risk for HF hospitalization (HFH) is investigated in this paper. Implantable devices collect HF related diagnostics, such as intrathoracic impedance, atrial fibrillation (AF) burden, ventricular rate during AF, night heart rate, heart rate variability, and patient activity, on a daily basis. Features were extracted that encoded information regarding out of normal range values as well as temporal changes at weekly and monthly time scales. A BBN is used to combine the features to generate a risk score defined as the probability of a HFH given the diagnostic evidence. Patients with a very high risk score at follow-up are 15 times more likely to have a HFH in the next 30 days compared to patients with a low-risk score. The combined score has improved ability to identify patients at risk for HFH compared to the individual diagnostic parameters. A score of this nature allows clinicians to manage patients by exception; a patient with higher risk score needs more attention than a patient with lower risk score. PMID:22835530

Sarkar, Shantanu; Koehler, Jodi

2013-01-01

 
 
 
 
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The high-risk myocardial infarction database initiative.  

Science.gov (United States)

Coronary artery disease and myocardial infarction represent a major cause of morbidity and mortality. Four randomized, controlled, double-blind clinical trials--VALIANT, EPHESUS, OPTIMAAL, and CAPRICORN evaluated pharmacologic intervention in a total of 28,771 high-risk patients following acute MI complicated with signs of heart failure or evidence of left ventricular dysfunction. The demographic profiles of the 4 study cohorts were similar. The High-Risk MI Database Initiative constructed a common database by merging the data captured by these 4 large trials. The merged data set did not contain the randomized study treatment, so no comparisons could be made between the agents investigated. A total of more than 17,600 subjects experienced a cardiovascular end point. Approximately 5100 deaths occurred, and more than 15,700 subjects experienced a hospitalization. The primary objectives of this initiative were to use this large database to define more precisely the prognostic profile of this high-risk population, to perform rigorous, adequately-sized, subset analyses, to provide epidemiologic information and event rate estimation based on baseline demographics. The methodological challenges and limitations of such an analyses are discussed. It is proposed that some thoughtful foresight and planning could enable us to use the large number of clinical events that accrue during randomized clinical trials to address questions of scientific and clinical interest. PMID:22226005

Dickstein, Kenneth; Bebchuk, Judith; Wittes, Janet

2012-01-01

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Simple Integer Risk Score to Determine Prognosis of Patients With Hypertension and Chronic Stable Coronary Artery Disease  

Science.gov (United States)

Background It is difficult to accurately determine prognosis of patients with hypertension and chronic stable coronary artery disease (CAD). Our aim was to construct a risk score for predicting important adverse events in this population. Methods and Results Patients with hypertension and chronic stable CAD enrolled in the INternational VErapamil?SR/Trandolapril STudy (INVEST) comprised the study cohort. Candidate predictor variables were obtained from patients with at least 1 postbaseline visit. Patients were divided into development (n=18 484) and validation cohorts (n=2054). Cox regression model identified predictors of the primary outcome: all?cause mortality, myocardial infarction, or stroke at a mean follow?up of 2.3 years. The hazard ratio of each variable was rounded to the nearest integer to construct score weights. A score 0 to 4 defined low?risk, 5 to 6 intermediate?risk and ?7 high?risk. The following variables were retained in the final model: age, residence, body mass index, on?treatment heart rate and BP, prior myocardial infarction, heart failure, stroke/transient ischemic attack, smoking, diabetes, peripheral arterial disease, and chronic kidney disease. The primary outcome occurred in 2.9% of the low?risk group, 6.5% of the intermediate?risk group, and 18.0% of the high?risk group (P for trend <0.0001). The model was good at discriminating those who had an event versus those who did not (C?statistic=0.75). The model performed well in a validation cohort (C?statistic=0.77). Conclusion Readily available clinical variables can rapidly stratify patients with hypertension and chronic stable CAD into useful risk categories.

Bavry, Anthony A.; Kumbhani, Dharam J.; Gong, Yan; Handberg, Eileen M.; Cooper-DeHoff, Rhonda M.; Pepine, Carl J.

2013-01-01

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

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Full Text Available 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 development and progression of this disease. This fact limits the utility of Framingham scoring when applied to individuals. Electron beam tomography (EBT, which measures coronary calcium, provides a non-invasive method for assessing coronary plaque burden, thus offering the possibility of providing a more accurate estimate of an individual's "arterial age" than from chronological age alone. Methods In this paper we discuss a new and simple method for incorporating the coronary calcium score (CCS to modify the Framingham Risk Assessment (FRA. Using this method, a coronary artery calcium (CAC age equivalent is generated that replaces chronological age in Framingham scoring. Results and discussion Using a percentile table of CCS scores by age group and sex, individuals are matched to the age group whose calcium score most closely approximates their own individual score. The original 10-year absolute risk score of a 65-year old man with a CCS of 6 based on chronological age is 10%, whereas the modified absolute risk score based on CAC age equivalents is 2%. Conclusion Our approach of replacing chronological age with CAC age equivalents in the Framingham equations possesses simplicity of application combined with precision. Physicians can easily derive adjusted Framingham risk scores and prescribe intervention methods based on patients' ten-year risks. The adjusted ten-year risks are likely to be more accurate than unadjusted risks since they are based on coronary calcium score information. The modified FRA approach not only may increase the predicted risk for some patients, but also may decrease the predicted risk for others, making it a more precise adjustment than other methods.

Whitcomb Brian W

2004-04-01

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Lipoprotein(a) and risk of myocardial infarction--genetic epidemiologic evidence of causality  

DEFF Research Database (Denmark)

Elevated levels of lipoprotein(a) are associated with an increased risk of myocardial infarction. Our study aimed to test whether genetic data are consistent with this association being causal. Accordingly, we developed a high-throughput realtime PCR assay to genotype for the lipoprotein(a) kringle IV type 2 (KIV-2) repeat polymorphism in the LPA gene in > 40,000 individuals. The LPA KIV-2 genotype associated with plasma levels of lipoprotein(a) (trend p <0.001), and the LPA KIV-2 genotype associated with risk of myocardial infarction (trend p <0.001 to 0.03) in a manner consistent with its effect on plasma levels of lipoprotein(a). The association of LPA KIV-2 genotypes raising plasma levels of lipoprotein(a) with increased risk of myocardial infarction strongly supports a causal association of lipoprotein(a) with risk of myocardial infarction.

Kamstrup, Pia R; Tybjærg-Hansen, Anne

2011-01-01

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Clopidogrel discontinuation after myocardial infarction and risk of thrombosis : a nationwide cohort study  

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The benefit of extending clopidogrel treatment beyond the 12-month period recommended in current guidelines after myocardial infarction (MI) is debated. We analysed the risk of adverse cardiovascular outcomes after discontinuation of 12 months of clopidogrel treatment.

Charlot, Mette; Nielsen, Lars Hougaard

2012-01-01

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Tar yield of cigarettes and risk of acute myocardial infarction. GISSI-EFRIM Investigators.  

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OBJECTIVE--To analyse the relation between tar and nicotine yield of cigarettes smoked in the recent past and the risk of myocardial infarction. DESIGN--Multicentre case-control study conducted between September 1988 and June 1989. SETTING--Over 80 coronary care units in various Italian regions. SUBJECTS--916 patients with acute myocardial infarction without history of ischaemic heart disease and 1106 controls admitted to hospital for acute conditions not related to known or suspected risk fa...

Negri, E.; Franzosi, M. G.; La Vecchia, C.; Santoro, L.; Nobili, A.; Tognoni, G.

1993-01-01

47

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

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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 study 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 s...

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

2011-01-01

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Relation Between ABO Blood Groups, Cardiovascular Risk Factors and Acute Myocardial Infarction  

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Different risk factors affect development of atherosclerosis and Coronary Artery Disease (CAD). These factors are believed to be of value in prediction and prevention of coronary events. Here in we report the relation between blood groups, cardiovascular risk factors and Myocardial Infarction incidence. Measurements were made in samples obtained from 500 patients who had admitted to Cardiac Care Unit (CCU) of Madani heart center of Tabriz, Iran due to first Acute Myocardial Infarction (AMI) f...

Farnaz Sepasi; Azin Alizadeh Asl; Rasoul Azarfarin

2008-01-01

49

Cardiovascular risk assessment scores for people with diabetes: a systematic review  

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People with type 2 diabetes have an increased risk of cardiovascular disease (CVD). Multivariate cardiovascular risk scores have been used in many countries to identify individuals who are at high risk of CVD. These risk scores include those originally developed in individuals with diabetes and those developed in a general population. This article reviews the published evidence for the performance of CVD risk scores in diabetic patients by: (1) examining the overall rationale for using risk s...

Chamnan, P.; Simmons, R. K.; Sharp, S. J.; Griffin, S. J.; Wareham, N. J.

2009-01-01

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

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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.

Waldomiro Carlos Manfroi

2002-04-01

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Inter-rater reliability of modified Alberta Stroke program early computerized tomography score in patients with brain infarction  

Science.gov (United States)

BACKGROUND: The Alberta Stroke Program Early Computerized Tomography Score (ASPECTS) was used to detect significant early ischemic changes on brain CT of acute stroke patients. We designed the modified ASPECTS and compared it to the above system based on the inter-rater reliability. METHODS: A cross-sectional validation study was conducted based on the inter-rater reliability. The CT images were chosen from the stroke data bank of Ghaem hospital, Mashhad in 2010. The inclusion criteria were the presence of middle cerebral artery territory infarction and performance of CT within 6 hours after stroke onset. Axial CT scans were performed on a third-generation CT scanner (Siemens, ARTX, Germany). Section thickness above posterior fossa was 10 mm (130 kV, 150 mAs). Films were made at window level of 35 HU. The brain CTs were scored by four independent radiologists based on the ASPECTS and modified ASPECTS. The readers were blind to clinical information except symptom side. Cochrane Q and Kappa tests served for statistical analysis. RESULTS: 24 CT scans were available and of sufficient quality. Difference in distribution of dichotomized ?7 and >7 ASPECT scores between four raters was significant (Q=13.071, df=3, p=0.04). Distribution of dichotomized <6 and ?6 scores based on modified ASPECT system between 4 raters was not significantly different (Q=6.349, df=3, p=0.096). CONCLUSIONS: Modified ASPECT method is more reliable than ASPECTS in detecting major early ischemic changes in stroke patients candidated to tPA thrombolysis.

Ghandehari, Kavian; Rezvani, Mohammad Reza; Shakeri, Mohammad Taghi; Mohammadifard, Mahdi; Ehsanbakhsh, Alireza; Mohammadifard, Mahyar; Mirgholami, Alireza; Boostani, Reza; Ghandehari, Kosar; Izadi-Mood, Zahra

2011-01-01

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The Selvester QRS Score is More Accurate than Q Waves and Fragmented QRS Complexes Using the Mason-Likar Configuration in Estimating Infarct Volume in Patients with Ischemic Cardiomyopathy  

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Infarct volume independently predicts cardiovascular events. Fragmented QRS complexes (fQRS) may complement Q-waves for identifying infarction; however, their utility in advanced coronary disease is unknown. We tested whether fQRS could improve the ECG prediction of infarct volume by PET in 138 patients with ischemic cardiomyopathy (EF 0.27±0.09). Indices of infarction (pathologic Q-waves, fQRS, and Selvester QRS Score) were analyzed by blinded observers. In patients with QRS duration <120ms...

Carey, Mary G.; Luisi, Andrew J.; Baldwa, Sunil; Al-zaiti, Salah; Veneziano, Marc J.; Dekemp, Robert A.; Canty, John M.; Fallavollita, James A.

2010-01-01

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Potential demographic and baselines variables for risk stratification of high-risk post-myocardial infarction patients in the era of implantable cardioverter-defibrillator - a prognostic indicator  

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BACKGROUND: Risk stratification after myocardial infarction (MI) remains expensive and disappointing. We designed a prognostic indicator using demographic information to select patients at risk of dying after MI. METHOD AND RESULTS: We combined individual patient data from the placebo arms of EMIAT, CAMIAT, TRACE and DIAMOND-MI with LVEF 10 ventricular premature beats/hour or a run of ventricular tachycardia). Risk factors for mortality beginning at day 45 post-MI up to 2 years were examined using Cox regression analysis. Risk scores were derived from the equation of a Cox regression model containing only significant variables. The prognostic index was the sum of the individual contribution from the risk factors. 2707 patients were pooled (age: 66 (23-92) years, 78.8% M) with 480 deaths at 2-years (44% arrhythmic and 35.6% non-arrhythmic cardiac deaths). Variables predicting mortality were age, sex, previous MI or angina, hypertension, diabetes, systolic blood pressure, heart rate, NYHA functional class and non-Q wave infarct on electrocardiogram. Distinct survival curves were obtained for 3 risk groups based on the median and inter-quartile range for the prognostic index. In the high-risk group, up to 40% of patients died (all-cause mortality), 19.1% died of arrhythmic and 18.2% died of non-arrhythmic cardiac causes at 2-years. CONCLUSION: In post-MI patients with LVEF Udgivelsesdato: 2008/5/7

Yap, Yee Guan; Duong, Trinh

2008-01-01

54

Metabolic syndrome and Framingham risk score in obese young adults  

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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

Felix F. Widjaja

2013-06-01

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Risk Assessment Using Two Different Diagnostic Tools: Metabolic Syndrome and Cardiovascular Risk Score (SCORE—Data from a Weight Reduction Intervention Study  

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Full Text Available Objective: Risk score models and the diagnosis of a metabolic syndrome are useful for cardiovascular (CV risk prediction. The identification of individuals with high CV and metabolic risk is essential to provide appropriate prevention and therapy. The present study aims at clarifying whether these indicators are altered by a weight reduction programme. Additionally, which diagnostic tool has a better predictive value is examined. Method: One hundred and twenty overweight and obese subjects aged 30 60 years were included in a 12-week weight reduction programme. The CV risk was assessed by means of German multiple-used risk charts (SCORE at baseline and at the end of the trial. Furthermore, the prevalence of the metabolic syndrome (three out of five risk factors was quantified. Results: The initial prevalence of the metabolic syndrome was 63.3% (n = 76 and decreased to 41.7% (n = 50 by the end of the intervention. The SCORE also decreased significantly after twelve weeks (p 5% was comparatively low (t0: 7.4%, n = 7; t12: 5.3%, n = 5. Conclusion: The weight reduction concept was applicable to improve the CV risk SCORE and decrease the prevalence of the metabolic syndrome. The CV 10-year risk calculated using German risk charts (SCORE probably underestimated the risk of CV diseases in this collective. In this case, the diagnosis of a metabolic syndrome is more meaningful than risk SCORE calculations.

Janina Willers

2013-09-01

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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  

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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.

Rodrigo H. Bagur

2009-10-01

57

Evaluation of the effect of primary PTCA for acute myocardial infarction my myocardial perfusion score  

International Nuclear Information System (INIS)

The aim of the study is to evaluate the perfusion defect after reperfusion therapy (primary PTCA) from Tc99m tetrofosmin SPECT study by perfusion score and to determine its relation to the left ventricular function, determined in dynamic by echocardiography. Twenty patients were examined: 14 men and 6 women, aged from 42 to 67: 11 with reperfusion of left anterior descendent artery (LAD), 4 - with reperfusion of circumflex artery (Rcx) and 5 - with right coronary artery (RCA) procedures. The perfusion score P was evaluated before discharge and at the 2nd month according to 4-degree scale (1- normal uptake, 4 - severe uptake reduction or lack of uptake). Dynamic in left ventricular ejection fraction (LVEF) and volumes (end diastolic EDV and end systolic ESV) as well as in the global wall motion score (GWMI) were determined by early and late (at the 2nd month) echocardiography. For GWMI determination a 4-grade scale was used: 1 - normo, 4 - dyskinesia. A 16 segments model of the left ventricle was chosen for both: echocardiography and SPECT for comparison of segments with perfusion and function disturbances. The decrease in P and GWMI means improvement. All patients were with TIMI 3 or 2 after procedure. Insignificant improvement in P from 1.61±0.39 to 1.52±0.46, p NS, and significant improvement in function were found for 2 months: in LVEF from 46.9±7.24.% to 59.5±13.0.%, in GWMI from 1.99±0.34 to 1.56±0.44, p>0.01. According to the discharge Pd the patients were distributed into: gr.1 Pd?1.3 (n=6) mild defects; gr.2 Pd >1.3<1.9 (n=9) moderate defects; gr.3 Pd?l.9 (n=5) large defects. Improvement in ESV, GWMI and LVEF and preserved function at the 2nd month was observed from gr.1 and 2. Gr. 3 had tendency of increase in ESV and EDV (LV dilatation) and patients were with LV dysfunction at the 2nd month. Mismatch between kinetic and perfusion scores - the GWMI/P ratio changed from 1.27±0.28 to 1.04±0.11, p<0.001 - stunning resolution and spontaneous kinetic improvement. The correlation between early Pd and peak enzyme values of CPK and MB was relatively good: for CPK r=0.570, p<0.014 for MB-fraction r=0.748, p<0.000. A good correlation was found between P at discharge and late functional data: for Pd and LVEF2m r=-0,853, p<0.000, for Pd and GWMI2m r=0.861, p<0.000. Pd is related to both: myocardial losses and prognosis. (authors)

2006-01-01

58

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

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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 study 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.

Oscar M. Martins

2011-01-01

59

Effects of resting ischemia assessed by thallium scintigraphy on QRS scoring system for estimating left ventricular function quantified by radionuclide angiography in acute myocardial infarction patients  

International Nuclear Information System (INIS)

The purpose of this study was to determine whether resting ischemia limits the usefulness of the QRS scoring system in predicting left ventricular (LV) ejection fraction (EF) in patients with acute infarction. We studied 48 patients after acute infarction by means of 12-lead ECG, thallium-201 scintigraphy, and radionuclide angiography. The thallium-201 scintigrams showed fixed defects in 25 patients, perfusion defects with partial or complete redistribution in the delayed images in 19 patients, and normal images in the remaining four patients. In the 48 patients there was a significant correlation between the QRS score and LVEF (r . -0.67; p less than 0.001). Patients with fixed defects showed a better correlation than patients with resting ischemia (r . -0.77 vs r . -0.60). A QRS score of 3 or less was used to separate patients with LVEF of 40% or greater from those with lower LVEF in patients with fixed defects (p . 0.0005), but this cutoff did not categorize patients with resting ischemia as to LVEF. Thus the presence of rest ischemia in patients with acute infarction may affect the correlation between QRS score and LVEF

1984-01-01

60

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

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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) â?¥ 48 mmol/mol (â?¥ 6.5%)] and diabetes or impaired glycaemia [HbA(1c) â?¥ 42 mmol/mol (â?¥ 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.

Handlos, Line Neerup; Witte, Daniel Rinse

2013-01-01

 
 
 
 
61

Mortality Risk Prediction by Application of PRISM Scoring System in Pediatric Intensive Care Unit  

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Full Text Available Objective: The Pediatric Risk of Mortality (PRISM score is one of the scores used by many pediatricians for prediction of the mortality risk in the pediatric intensive care unit (PICU. Herein, evaluate the efficacy of PRISM score in prediction of mortality rate in PICU.Methods: In this cohort study, 221 children admitted during an 18-month period to PICU, were enrolled. PRISM score and mortality risk were calculated. Follow up was noted as death or discharge. Results were analyzed by Kaplan-Meier curve, ROC curve, Log Rank (Mantel-Cox, Logistic regression model using SPSS 15.Findings: Totally, 57% of the patients were males. Forty seven patients died during the study period. The PRISM score was 0-10 in 71%, 11-20 in 20.4% and 21-30 in 8.6%. PRISM score showed an increase of mortality from 10.2% in 0-10 score patients to 73.8% in 21-30 score ones. The survival time significantly decreased as PRISM score increased (P?0.001. A 7.2 fold mortality risk was present in patients with score 21-30 compared with score 0-10. ROC curve analysis for mortality according to PRISM score showed an under curve area of 80.3%.Conclusion: PRISM score is a good predictor for evaluation of mortality risk in PICU.

Mahdi Mohammadi

2013-10-01

62

Coronary artery calcium scoring.  

Science.gov (United States)

Numerous clinical studies have shown that coronary artery calcium scoring provides substantial incremental risk prediction beyond conventional coronary risk factors for coronary heart disease events. About half of all patients with coronary artery disease (CAD) present initially with unexpected myocardial infarction or sudden death. Early identification of this subgroup of patients is vital for institution of intensive, early preventive measures to decrease morbidity and mortality due to CAD. PMID:21796088

Mehra, Sanjay; Movahed, Hossein; Movahed, Assad

2011-01-01

63

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)

Full Text Available SciELO Argentina | Language: Spanish Abstract in spanish 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

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

64

Comparison of the TIMI and the GRACE risk scores with the extent of coronary artery disease in patients with non-ST-elevation acute coronary syndrome  

International Nuclear Information System (INIS)

Objective: To compare the accuracy of the Global Registry of Acute Coronary Events risk score and the Thrombolysis In Myocardial Infarction risk score in predicting the extent of coronary artery disease in patients with non-ST segment elevation acute coronary syndrome. Methods: The cross-sectional study comprising 406 consecutive patients was conducted at the National Institute of Cardiovascular Diseases, Karachi, from August 2010 to March 2011. For all patients, the GRACE and TIMI RS's relevant scores on the two indices were calculated on admission using specified variables. The patients underwent coronary angiography to determine the extent of the disease. A significant level was defined as >70% stenosis in any major epicardial artery or >50% stenosis in the left main coronary artery. SPSS 19 was used for statistical analysis. Results: Both the indices showed good predictive value in identifying the extent of the disease. A Thrombolysis In Myocardial Infarction score >4 and Global Registry of Acute Coronary Events score >133 was significantly associated with 3vessel disease and left main disease, while for the former score <4 and latter score <133 was associated with normal or non-obstructive coronary disease (p<0.01). On comparison of the two risk scores, the discriminatory accuracy of the latter was significantly superior to the former in predicting 2vessel, 3vessel and left main diseases (p<0.05). Conclusion: Although both the indices were helpful in predicting the extent of the disease, the Global Registry showed better performance and was more strongly associated with multi-vessel and left main coronary artery disease. (author)

2013-06-01

65

The Value of Simplified Selvester QRS Scoring System in Predicting ST-segment Resolution after Thrombolysis in Patients with Acute Myocardial Infarction  

Directory of Open Access Journals (Sweden)

Full Text Available ABSTRACT Background: Selvester QRS scoring system was developed for estimating the infarct size from the electrocardiogram (ECG. Objective: To evaluate the predictive value of the simplified version of this scoring system on ST-segment resolution (STR mortality in patients with acute ST-elevation myocardial infarction (STEMI undergoing thrombolytic therapy (TLT. Methods: We enrolled 100 consecutive patients with their first acute STEMI within 12 hours of onset of chest pain who were candidates for TLT. The Selvester QRS score was estimated on the first admission ECG. Sum of ST-segment elevation amount in millimeters was measured immediately before and 90 minutes after TLT. The difference between these two was measured and expressed as sum of STR (sSTR. All subjects were categorized into two groups: those with sSTR? 50% and others with sSTR<50%. Results: Mean Selvester QRS score was significantly lower in the sSTR? 50% vs. sSTR<50% group (2.62±1.50 vs. 8.02±2.96; p= 0.001. Using a cutoff value of ?3.5 points, the Selvester score had a sensitivity of 81%, specificity of 70%, PPV of 81% and NPV of 70% in predicting sSTR< 50%. Those with anterior STEMIs had larger scores (p< 0.0001 and showed more no-reflow than inferior STEMIs (p= 0.001. Low left ventricular function was associated with higher QRS scores (p= 0.02. During a mean follow up period of about 13±1.7 months, 18.6% of patients with a Selvester score ?3.5 died compared to 4.4% in the other group (p=0.03. Conclusion: The Selvester QRS score with ?3.5 points on admission ECG predicts incomplete STR after TLT. These patients experience higher mortality during one year follow up.

Samad Ghaffari

2014-02-01

66

Myocardial infarction in young men. Study of risk factors in nine countries.  

Science.gov (United States)

In order to determine whether the development of myocardial infarction in different countries is associated with different risk factors, 240 male survivors, aged 40 or less, were studied in nine countries. In the seven centres in developed countries (Auckland, Melbourne, Los Angles/Atlanta, Cape Town, Tel Avic, Heidelberg, and Edinburgh) there was a high procedure of risk factors, particularly of hyperlipidaemia and cigarette smoking. The prevalence of hypertension, obesity, hyperglycaemia, and hyperuricaemia varied from centre to centre. Risk factors were less prevalent in Bombay and Singapore: the most common risks operating in Bombay seemed to be cigarette smoking and hyperglycaemia, while in Singpore cigarette smoking was the commonest. The mean age of the whole group was 35.4 years. Serum cholesterol levels of 7.25 mmol/l (280 mg/dl) or more were present in 25 per cent of all patients, serum triglyceride levels of 2.26 mmol/l )l200 mg/dl) or more in 35 per cent. 80 per cent of the patients were smokers, and 15 per cent were either for hypertension before myocardial infarction or had a raised blood pressure after myocardial infarction. Obesity was found in 19 per cent of all patients and serum uric acid levels over 0.5 mmol/l (8.5 mg/dl) in 17 per cent. 10 per cent of all patients were either treated for diabetes mellitus before myocardial infarction or showed an abnormal glucose tolerance after myocardial infarction. This collaborative study may help, by showing differences in the prevalence of risk factors, to indicate to each centre and to national and to international organizations, the direction for their future studies into the causation and prevention of myocardial infarction in young men. PMID:1137658

Dolder, M A; Oliver, M F

1975-05-01

67

IS OPIUM ADDICTION A RISK FACTOR FOR ACUTE MYOCARDIAL INFARCTION?  

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There is a misconception among our people that opioids may prevent or have ameliorating effects in the occurrence of cardiovascular diseases. In this study we evaluated 556 consecutive male patients hospitalized due to acute myocardial infarction (MI) in city of Yazd, from May 2000 to October 2001 and compared the characteristics of opium addicts to non opium users. Prevalence of opium addiction in MI patients was 19% in comparison with 2-2.8% in general population. There were not any differe...

Sadr Bafghi, S. M.; Rafiei, M.; Bahadorzadeh, L.; Namayeh, S. M.; Soltani, M. H.; Andishmand, M. Motafaker A.

2005-01-01

68

Fibrinogen as a risk factor for premature myocardial infarction in Iranian patients: A case control study  

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Full Text Available Mohammad Shojaie, Morteza Pourahmad, Ahad Eshraghian, Hamid Reza Izadi, Farzan NaghshvarPeymanieh Hospital, Internal Medicine Department, Jahrom University of Medical Sciences, Jahrom, Fars, IranBackground: Premature myocardial infarction with life-threatening complications may become epidemic in some Asian and African countries and especially Iran. Fibrinogen is considered as one of the probable risk factors of myocardial infarction. The aim of our study was to assess fibrinogen levels as an etiology of premature myocardial infarction in young Iranian men.Findings: A case-control study was conducted between May 2005 and May 2007 to investigate the association between serum total fibrinogen level and myocardial infarction in men aged younger than 55 years admitted to the cardiac care units of Peymanieh and Motahari Hospitals affiliated to Jahrom University of Medical Sciences, Iran. The mean age of patients was 45.2 ± 4 years in patients with premature myocardial infarction and 47.06 ± 4.5 years in the control group (p = 0.085. There were no statistically significant relationships between the two groups in history of premature myocardial infarction in their first-degree relatives (p = 0.05, cigarette smoking (p = 0.46, diabetes (p = 0.49, or hypertension (p = 1. The mean plasma fibrinogen in patients (354.9 ± 60 mg/dL was elevated markedly compared with the control group (329 ± 73 mg/dL. Hyperfibrinogenemia (>340 mg/dL was detected in 81.8% of patients and 57.5% of controls (95% confidence interval, odds ratio = 3.3; p = 0.036.Conclusion: This study introduced fibrinogen as a risk factor for premature coronary artery disease in Iranian men.Keywords: myocardial infarction, cigarette, hypertension, diabetes, fibrinogen

Mohammad Shojaie

2009-08-01

69

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

DEFF Research Database (Denmark)

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.

Saidj, Madina; Jørgensen, Torben

2013-01-01

70

MODALITY OF DETERMINING THE TOTAL SCORE OF RISKS IN INTERNAL AUDIT  

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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.

FRANCA DUMITRU

2012-11-01

71

A Clinical Risk Score for Atrial Fibrillation in a Biracial Prospective Cohort (From the Atherosclerosis Risk in Communities (ARIC) Study)  

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A risk score for AF has been developed by the Framingham Heart Study; however the applicability of this risk score, derived from whites, to predict new-onset AF in non-whites is uncertain. Therefore, we developed a 10-year risk score for new-onset AF using risk factors commonly measured in clinical practice using 14,546 individuals from the Atherosclerosis Risk in Communities study, a prospective community-based cohort of blacks and whites in the United States. During 10 years of follow-up, 5...

Chamberlain, Alanna M.; Agarwal, Sunil K.; Folsom, Aaron R.; Soliman, Elsayed Z.; Chambless, Lloyd E.; Crow, Richard; Ambrose, Marietta; Alonso, Alvaro

2011-01-01

72

Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction  

DEFF Research Database (Denmark)

Mitral regurgitation (MR) has been associated with adverse outcomes after myocardial infarction (MI). Without structural valve disease, functional MR has been related to left ventricular (LV) remodeling and geometric deformation of the mitral apparatus. The aims of this study were to elucidate the mechanistic components of MR after high-risk MI and to identify predictors of MR progression during follow-up.

Meris, Alessandra; Amigoni, Maria

2012-01-01

73

Validating the Framingham Hypertension Risk Score: results from the Whitehall II study  

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A promising hypertension risk prediction score using data from the United States Framingham Offspring study has been developed, but this score has not been tested in other cohorts. We examined the predictive performance of the Framingham hypertension risk score in a European population, the Whitehall II study. Participants were 6704 London-based civil servants aged 35 to 68, 31% women, free from prevalent hypertension, diabetes and coronary heart disease. Standard clinical examinations of blo...

Kivima?ki, Mika; Batty, G. David; Singh-manoux, Archana; Ferrie, Jane E.; Tabak, Adam G.; Jokela, Markus; Marmot, Michael G.; Smith, George Davey; Shipley, Martin J.

2009-01-01

74

Quality of life four years after acute myocardial infarction: short form 36 scores compared with a normal population  

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OBJECTIVES—To assess the impact of myocardial infarction on quality of life in four year survivors compared to data from "community norms", and to determine factors associated with a poor quality of life.?DESIGN—Cohort study based on the Nottingham heart attack register.?SETTING—Two district general hospitals serving a defined urban/rural population.?SUBJECTS—All patients admitted with acute myocardial infarction during 1992 and alive at a median of four yea...

1999-01-01

75

[Cardiovascular risk factors on the Framingham Risk Score among hypertensive patients attended by family health teams].  

Science.gov (United States)

The Framingham Risk Score (FRS) is used to stratify cardiovascular risk. This study sought to identify the prevalence of risk factors used in the FRS and the use of drugs that reduce cardiovascular risk among hypertensive patients attended by the Family Health Strategy (FHS). It is cross-sectional study, which evaluated a random sample of hypertensive patients in the FHS in northern Minas Gerais. Data were collected through interviews and from medical records. 505 hypertensive patients were evaluated in 9 municipalities of the region, with a predominance of women; 325 (64.4%), mean age of 66.4 years. In 90% of hypertensive patients there was at least one associated risk factor. The grouping of three or more factors occurred in 79 (15.7%) patients. Dyslipidemia was found in 188 (37.2%), diabetes in 101 (20%) and smoking in 36 (7.1%). The use of anti-hypertensive drugs was observed in 481 (95.2%) patients. The use of other cardioprotective drugs was higher among patients with 3 or more risk factors: 45.6% used antiplatelet and 27.8% used lipid-lowering drugs. The prevalence of risk factors from the FRS in the population studied was quite high and the use of cardioprotective drugs was seen to be restricted. Strategies to increase the use of FRS may improve the management of hypertension in the FHS. PMID:24897474

Pimenta, Henderson Barbosa; Caldeira, Antônio Prates

2014-06-01

76

Genetic risk score and adiposity interact to influence triglyceride levels in a cohort of Filipino women.  

Science.gov (United States)

Background/Objectives:Individually, genetic variants only moderately influence cardiometabolic (CM) traits, such as lipid and inflammatory markers. In this study we generated genetic risk scores from a combination of previously reported variants influencing CM traits, and used these scores to explore how adiposity levels could mediate genetic contributions to CM traits.Subjects/Methods:Participants included 1649 women from the 2005 Cebu Longitudinal Health and Nutrition Survey. Three genetic risk scores were constructed for C-reactive protein (CRP), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs). We used linear regression models to assess the association between each genetic risk score and its related trait. We also tested for interactions between each score and measures of adiposity.Results:Each genetic risk score explained a greater proportion of variance in trait levels than any individual genetic variant. We found an interaction between the TG genetic risk score (2.29-14.34 risk alleles) and waist circumference (WC) (Pinteraction=1.66 × 10(-2)). Based on model predictions, for individuals with a higher TG genetic risk score (75th percentile=12), having an elevated WC (?80?cm) increased TG levels from 1.32 to 1.71?mmol?l(-1). However, for individuals with a lower score (25th percentile=7), having an elevated WC did not significantly change TG levels.Conclusions:The TG genetic risk score interacted with adiposity to synergistically influence TG levels. For individuals with a genetic predisposition to elevated TG levels, our results suggest that reducing adiposity could possibly prevent further increases in TG levels and thereby lessen the likelihood of adverse health outcomes such as cardiovascular disease. PMID:24932782

Zubair, N; Mayer-Davis, E J; Mendez, M A; Mohlke, K L; North, K E; Adair, L S

2014-01-01

77

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

DEFF Research Database (Denmark)

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.

Bang, Casper N; Gislason, Gunnar H

2012-01-01

78

Value of planar 201Tl imaging in risk stratification of patients recovering from acute myocardial infarction  

Energy Technology Data Exchange (ETDEWEB)

Although exercise ECG testing has been shown to have important prognostic value after acute myocardial infarction, exercise 201Tl scintigraphy offers several potential advantages, including: (1) increased sensitivity for detecting residual myocardial ischemia; (2) the ability to localize ischemia to a specific area or areas subtended by a specific coronary artery; (3) the ability to identify exercise-induced left ventricular dysfunction, which is manifested by increased lung uptake or transient left ventricular dilation; and (4) more reliable risk stratification of individual patients. The more optimal prognostic efficiency of 201Tl scintigraphy partially results from the fact that the error rate in falsely classifying patients as low risk is significantly smaller with 201Tl scintigraphy than with stress ECG. Because of these substantial advantages, there seems to be adequate rationale for recommending exercise perfusion imaging rather than exercise ECG alone as the preferred method for evaluating mortality and morbidity risks after acute myocardial infarction.

Gibson, R.S.; Watson, D.D. (Medical Center, University of Virginia Health Sciences Center, Charlottesville (United States))

1991-09-01

79

Estimating Risk of Alcohol Dependence Using Alcohol Screening Scores*  

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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...

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

2010-01-01

80

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)

Full Text Available SciELO Brazil | Language: English Abstract in english 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.

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

 
 
 
 
81

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

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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 extracorporeal 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<0.001 and 15.7 days vs. 10.6 days; p<0.05 respectively than those of the control. CONCLUSION: Only previous myocardial revascularization was an independent predictor of acute myocardial infarction in the postoperative period, based on multivariate logistic regression analysis.

José Ribamar Costa Jr.

2003-03-01

82

Should pulse pressure become part of the Framingham risk score?  

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An increased pulse pressure suggests aortic stiffening. New evidence also suggests that pulse pressure is a more sensitive measure of risk than other indexes of blood pressure in middle-aged and older persons. The objective of the study was to relate pulse pressure to the risk of cardiovascular events in the general population, and to assess whether pulse pressure could improve the Framingham risk prediction. A total of 378 men and 391 women over the age of 50 years (mean 62.7 years) were fol...

Nawrot, T. S.; Staessen, Jan A.; Thijs, Lutgarde; Fagard, Robert; Tikhonoff, V.; Wang, J-g; Franklin, S. S.

2004-01-01

83

The inter-relationship of diabetes and left ventricular systolic function on outcome after high-risk myocardial infarction  

DEFF Research Database (Denmark)

Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myocardial infarction (MI). Whether diabetes modifies the relationship between left ventricular ejection fraction (LVEF) and outcomes in the post-MI population is unknown.

Shah, Amil M; Uno, Hajime

2010-01-01

84

Troponin I level in risk stratification of non-ST-elevation myocardial infarction in smokers  

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Full Text Available A prospective study was carried out to evaluate the role of troponin I in risk stratification of non-ST-elevation myocardial infarction in 40 smoker and 40 non-smoker patients. The troponin I was significantly higher (p<0.001 in smokers (35.5 ± 5.22 ng/mL than non-smoker (0.27 ± 0.01 ng/mL. The duration of hospital stay was longer in Group I (106.6 ± 2.36 hour than in Group II (49.20 ± 1.01 hour. The major adverse cardiac event was higher in smoker (71.79% compared to non-smokers (10.8%. So, it may be concluded that higher value of troponin I with history of smoking in non-ST-elevation myocardial infarction may be considered as ‘high risk group’ patients.

Iram Shahriar, Shahina Sobhan and Ziarrat Islam

2010-12-01

85

Development of gene expression-based risk score in cytogenetically normal acute myeloid leukemia patients.  

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Patients with normal karyotype represent the single largest cytogenetic group of acute myeloid leukemia (AML), with highly heterogeneous clinical and molecular characteristics. In this study, we sought to determine new prognostic biomarkers in cytogenetically normal (CN)-AML patients. A gene expression (GE)-based risk score was built, summing up the prognostic value of 22 genes whose expression is associated with a bad prognosis in a training cohort of 163 patients. GE-based risk score allowe...

Samra, Elias Bou; Klein, Bernard; Commes, The?re?se; Moreaux, Je?ro?me

2012-01-01

86

Development of gene expression-based risk score in cytogenetically normal acute myeloid leukemia patients  

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Patients with normal karyotype represent the single largest cytogenetic group of acute myeloid leukemia (AML), with highly heterogeneous clinical and molecular characteristics. In this study, we sought to determine new prognostic biomarkers in cytogenetically normal (CN)-AML patients. A gene expression (GE)-based risk score was built, summing up the prognostic value of 22 genes whose expression is associated with a bad prognosis in a training cohort of 163 patients. GE-based risk score allowe...

Bou Samra, Elias; Klein, Bernard; Commes, The?re?se; Moreaux, Je?ro?me

2012-01-01

87

Risk-adjusting acute myocardial infarction mortality: are APR-DRGs the right tool?  

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OBJECTIVE: To determine if a widely used proprietary risk-adjustment system, APR-DRGs, misadjusts for severity of illness and misclassifies provider performance. DATA SOURCES: (1) Discharge abstracts for 116,174 noninstitutionalized adults with acute myocardial infarction (AMI) admitted to nonfederal California hospitals in 1991-1993; (2) inpatient medical records for a stratified probability sample of 974 patients with AMIs admitted to 30 California hospitals between July 31, 1990 and May 31...

Romano, P. S.; Chan, B. K.

2000-01-01

88

Risk factors for myocardial infarction among low socioeconomic status South Indian population  

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Abstract Background As longevity increases, cases of myocardial infarction (MI) are likely to be more. Cardiovascular disease (CVD) is a major global health problem reaching epidemic proportions in the Indian subcontinent, also among low socio-economic status (SES) and thin individuals. Objectives The present study was undertaken to elicit risk factors for MI among low SES Southern Indians and to find out its association with body mass index (BMI). Materi...

Meenakshisundaram Ramachandran; Agarwal Dipti; Rajendiran Chinnaswamy; Thirumalaikolundusubramanian Ponniah

2010-01-01

89

Conjugated linoleic acid in adipose tissue and risk of myocardial infarction123  

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Background: Despite the high saturated fat content of dairy products, no clear association between dairy product intake and risk of myocardial infarction (MI) has been observed. Dairy products are the main source of conjugated linoleic acid (CLA; 18:2n?7t), which is produced by the ruminal biohydrogenation of grasses eaten by cows. Pasture-grazing dairy cows have more CLA in their milk than do grain-fed cows. Some animal models have reported beneficial effects of CLA on atherosclerosis.

2010-01-01

90

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

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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...

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

91

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

Science.gov (United States)

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

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

2014-01-01

92

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

LENUS (Irish Health Repository)

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.

Cooney, Marie Therese

2009-06-01

93

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

Directory of Open Access Journals (Sweden)

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.

I Ramsay

2012-11-01

94

Rockall score for risk stratification in adult patients with non-variceal upper gastrointestinal hemorrhage.  

Science.gov (United States)

The Rockall risk score is a simple, validated predictive index that may serve as a useful clinical decision for assessing the risk of subsequent adverse outcomes in patients with non-variceal upper gastrointestinal hemorrhage (UGIH). The observational study was carried out over a period of 6 months from 10th July, 2012 to 09th January, 2013 in Department of Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh. A total of 60 patients with non-variceal UGIH were taken for the study during study period to see risk stratification by Rockall score and short term hospital outcome in non-variceal upper GI hemorrhage patients. Categorical variables were reported as percentage and Means and proportions were carried out using the Chi-square test of different variables. Among study population age distribution were 42(70%) 8). Outcome after initial Rockall scoring and endoscopy were found that 7(11.7%) died, 46(76.6%) survived and 7(11.7%) patients survived with complication. This study showed that Rockall score of ?3 was predictive of low risk of adverse outcomes, and a score of ?8 was predictive of high mortality and was useful in identifying patients with non-variceal UGIH who had low-risk scores in order to triage appropriately, without affecting patient outcomes. PMID:24292298

Rahman, M W; Sumon, S M; Amin, M R; Kahhar, M A

2013-10-01

95

What does my patient's coronary artery calcium score mean? Combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk  

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Abstract Background The coronary artery calcium (CAC) score is an independent predictor of coronary heart disease. We sought to combine information from the CAC score with information from conventional cardiac risk factors to produce post-test risk estimates, and to determine whether the score may add clinically useful information. Methods We measured the independent cross-sectional associations between conventional cardiac risk factors and the CAC score among a...

2004-01-01

96

Genetic polymorphism of CYP1A2 increases the risk of myocardial infarction  

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Background: There is growing evidence that DNA damage caused by mutagens found in tobacco smoke may contribute to the development of coronary heart disease (CHD). In order to bind to DNA many mutagens require metabolic activation by cytochrome P450 (CYP) 1A1 or CYP1A2. The objective of this study was to determine the effects of CYP1A1 and CYP1A2 genotypes on risk of myocardial infarction (MI) and whether smoking interacts with genotype to modify risk.

Cornelis, M.; El-sohemy, A.; Campos, H.

2004-01-01

97

Diuretic-gene interaction and the risk of myocardial infarction and stroke  

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This study investigates whether the interaction between diuretics and alphaadducin (ADD1) G460W or G-protein b3-subunit (GNB3) rs2301339 polymorphism modifies the risk of myocardial infarction (MI) or stroke. Data were used from the Rotterdam Study. The drug–gene interaction was determined with a Cox proportional hazard model with adjustment for each drug class as time-dependent covariates. The risk of MI in current users of low-ceiling diuretics with one or two copies of ...

Schelleman, H.; Klungel, O. H.; Witteman, J. C. M.; Breteler, M. M. B.; Hofman, A.; Duijn, C. M.; Boer, A.; Stricker, B. H. Ch

2006-01-01

98

Prognostic implications of cardiac scintigraphic parameters obtained in the early phase of acute myocardial infarction  

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A cohort of 76 patients with acute myocardial infarction was studied with infarct-avid scan, radionuclide ventriculography, and thallium-201 myocardial perfusion scintigraphy. Infarct area, left ventricular ejection fraction, and defect score were calculated as radionuclide indices of the extent of myocardial infarction. The correlation was studied between these indices and cardiac events (death, congestive heart failure, postinfarction angina, and recurrence of myocardial infarction) in the first postinfarction year. High-risk patients (nonsurvivors and patients who developed heart failure) had a larger infarct area, a lower left ventricular ejection fraction, and a larger defect score than the others. Univariate linear discriminant analysis was done to determine the optimal threshold of these parameters for distinguishing high-risk patients from others. Radionuclide parameters obtained in the early phase of acute myocardial infarction were useful for detecting both patients with grave complications and those with poor late prognosis during a mean follow-up period of 2.6 years.

Suzuki, A.; Matsushima, H.; Satoh, A.; Hayashi, H.; Sotobata, I.

1988-06-01

99

Cardiovascular Outcomes in the Outpatient Kidney Transplant Clinic: The Framingham Risk Score Revisited  

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Background and objectives: Cardiovascular disease is an important cause of morbidity and death in kidney transplant recipients. This study examines the Framingham risk score's ability to predict cardiac and stroke events. Because cyclosporine and tacrolimus have different cardiovascular risk profiles, these agents were also examined.

2008-01-01

100

Low amniotic fluid index in high risk pregnancy and poor apgar score at birth  

International Nuclear Information System (INIS)

To determine the accuracy of antepartum Amniotic Fluid Index (AFI) of 5 cm was labeled as predictor of good outcome at birth. The subjects in both the groups were demographically matched and fulfilled the inclusion and exclusion criteria. The Apgar score was calculated at 5 minutes of birth. The newborns, with Apgar score 6 were labeled as healthy. AFI was compared with Apgar score, using Chi-square and a p-value was calculated to determine the statistical significance. Sensitivity, specificity, efficiency and the predictive values of AFI at a cut off point of < 5 cm as a predictor of adverse outcome at birth (Apgar score of < 6 at 5 minutes of birth) in high-risk pregnancy were calculated. Only 8 neonates of 50 women with low AFI had low Apgar score. Similarly, 6 neonates of 50 women with normal AFI had poor Apgar score. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and efficiency of AFI as test were 57.1%, 51.3%, 16%, 88% and 52% respectively. Low AFI is a poor predictor of adverse outcome for high-risk term patients. AFI is not a good screening test for high-risk pregnant women at term for birth of an infant with low Apgar score. (author)

2008-10-01

 
 
 
 
101

Prognostic value of heart rate turbulence for risk assessment in patients with unstable angina and non-ST elevation myocardial infarction  

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Full Text Available Patricia RE Harris,1 Phyllis K Stein,2 Gordon L Fung,3 Barbara J Drew4 1Electrocardiographic Monitoring Research Laboratory, School of Nursing, Department of Physiological Nursing, University of California, San Francisco, CA, USA; 2Heart Rate Variability Laboratory, School of Medicine, Division of Cardiology, Washington University, St Louis, MO, USA; 3Cardiology Services, Department of Medicine, 4School of Nursing, Department of Physiological Nursing, Division of Cardiology, University of California, San Francisco, CA, USA Background: We sought to examine the prognostic value of heart rate turbulence derived from electrocardiographic recordings initiated in the emergency department for patients with non-ST elevation myocardial infarction (NSTEMI or unstable angina. Methods: Twenty-four-hour Holter recordings were started in patients with cardiac symptoms approximately 45 minutes after arrival in the emergency department. Patients subsequently diagnosed with NSTEMI or unstable angina who had recordings with ?18 hours of sinus rhythm and sufficient data to compute Thrombolysis In Myocardial Infarction (TIMI risk scores were chosen for analysis (n = 166. Endpoints were emergent re-entry to the cardiac emergency department and/or death at 30 days and one year. Results: In Cox regression models, heart rate turbulence and TIMI risk scores together were significant predictors of 30-day (model chi square 13.200, P = 0.001, C-statistic 0.725 and one-year (model chi square 31.160, P < 0.001, C-statistic 0.695 endpoints, outperforming either measure alone. Conclusion: Measurement of heart rate turbulence, initiated upon arrival at the emergency department, may provide additional incremental value in the risk assessment for patients with NSTEMI or unstable angina. Keywords: acute coronary syndrome, electrocardiographic monitoring, heart rate turbulence, non-ST elevation myocardial infarction, outcomes, prognosis, unstable angina

Harris PRE

2013-08-01

102

Correlation between the FINish diabetes risk score and the severity of coronary artery disease  

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Full Text Available Background/Aim. The FINish Diabetes RIsk SCore (FINDRISC which includes age, body mass index (BMI, waist circumference, physical (in activity, diet, arterial hypertension, history of high glucose levels, and family history of diabetes, is of a great significance in identifying patients with impaired glucose tolerance and a 10-year risk assessment of developing type 2 diabetes in adults. Due to the fact that the FINDRISC score includes parameters which are risk factors for coronary artery disease (CAD, our aim was to determine a correlation between this score, and some of its parameters respectively, with the severity of angiographically verified CAD in patients with stable angina in two ways: according to the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX score and the number of diseased coronary arteries. Methods. The study included 70 patients with stable angina consecutively admitted to the Clinic of Cardiology, Military Medical Academy, Belgrade. The FINDRISC score was calculated in all the patients immediately prior to angiography. Venous blood samples were collected and inflammatory markers [erythrocyte sedimentation rate (ESR, leucocytes, C-reactive protein (CRP, total cholesterol, HDL cholesterol, triglycerides and fasting glucose] determined. Coronary angiography was performed in order to determine the severity of coronary artery disease according to the SYNTAX score and the number of affected coronary vessels: 1-vessel, 2-vessel or 3-vessel disease (hemodynamically significant stenoses: more than 70% of the blood vessel lumen. The patients were divided into three groups regarding the FINDRISC score: group I: 5-11 points; group II: 12-16 points; group III: 17-22 points. Results. Out of 70 patients (52 men and 18 women enrolled in this study, 14 had normal coronary angiogram. There was a statistically significant positive correlation between the FINDRISC score and its parameters respectively (age, body mass index-BMI, waist circumference and the severity of CAD according to the SYNTAX score (p < 0.001 and the number of diseased coronary arteries (p < 0.001. The patients with higher FINDRISC score (groups II and III had more severe and extensive CAD according to the SYNTAX score than the group I. The odds ratio with 95% confidence intervals (CI between the group III and the group I was 5.143 (95% CI 1.299-20.360, p = 0.002 and between the group II and the group I 5.867 (95% CI 1.590- 21.525, p = 0.007. There were no differences in odds ratio for multivessel disease according to FINDRISC score between the group II and the group III [1.141; (95% CI 0.348-3.734. In the group I mean SYNTAX score was 5.18, and more than 70% of patients had normal coronary angiogram. In the group II mean SYNTAX score was 17.06, and more than 70% of patients had 2-vessel disease and 3- vessel disease, and in the group III mean SYNTAX score was 18.89, and 2-vessel and 3-vessel disease had 36.36% and 31.82% patients, respectively. In multiple regression analysis, where SYNTAX score was dependent variable, and age, BMI, waist circumference, FINDRISC score were independent variables, we found that only FINDRISC score was independent predictor of SYNTAX score. Conclusion. The obtained results suggest a statistically significant correlation between the FINDRISC score and its parameters (age, BMI, waist circumference and the severity of CAD according to the SYNTAX score and the number of diseased coronary arteries. The FINDRISC score may be useful in identifying patients at the high risk for coronary artery disease.

?uri? Predrag

2014-01-01

103

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

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was 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

1987-07-01

104

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

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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.

Mahmood Hajiahmadi

2010-12-01

105

Correlation between Umbilical Cord pH and Apgar Score in High-Risk Pregnancy  

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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.

Mousa Ahmadpour-Kacho

2010-12-01

106

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

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Full Text Available

  • 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 retinopathy. The cut-off value for the risk score was determined using the Receiver  perating Characteristic (ROC curve procedure.
  • RESULTS: According to final models, being male, having lower body mass index (BMI, being older, longer duration of diabetes and higher HbA1c were correlated with increased risk of diabetic retinopathy. Area under the Curve (ROC was 0.704 (95% CI: 0.685-0.723. A value ; 52.5 had the optimum sensitivity (60% and specificity (69% for determining diabetic retinopathy.
  • CONCLUSIONS: The results indicated that risk factors for retinopathy were sex, BMI, age, duration of diabetes and HbA1c levels. In onclusion, applying developed retinopathy risk score is a practical way to identify patients who are at high risk for developing diabetic retinopathy for an early treatment.
  • KEYWORDS: Retinopathy risk score, sensitivity, specificity, receiver operating characteristic curve.

Sayed Mohsen Hosseini

2009-04-01

107

German CABG Score: A Specific Risk Model for Patients Undergoing Isolated Coronary Artery Bypass Grafting.  

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Background?A specific risk model concerning mortality of patients undergoing isolated coronary artery bypass grafting (CABG) is developed based on the national quality benchmarking mandatory by law in Germany. Methods?On the basis of the national data pool from 2004, a risk score model for patients undergoing isolated CABG was developed and finally adjusted with the data of 43,145 patients of the year 2008. Modeling was performed by logistic regression analysis. This risk model was validated with the 2007 data pool which comprised 45,569 patients. Results?Observed in-hospital mortality after isolated CABG procedures was 3.0% in 2008. Hosmer-Lemeshow test p value was 0.189 and area under receiver operating characteristic curve was 0.826. Applying the German CABG score for 2007 resulted in an observed-to-expected mortality ratio of 1.01. Conclusion?The German CABG score for in-hospital mortality is a risk score with proven validity for isolated CABG, developed by means of the patient population in Germany. It can be used for the assessment of patient risk groups and for interhospital benchmarking. We encourage other researchers to apply and validate this score in comparable health care systems. PMID:24578036

Kötting, Joachim; Beckmann, Andreas; Döbler, Klaus; Schäfer, Elke; Veit, Christof; Welz, Armin; Schiller, Wolfgang

2014-06-01

108

Risk for myocardial infarction and stroke after community-acquired bacteremia : a 20-year population-based cohort study  

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BACKGROUND: 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. METHODS AND RESULTS: This population-based cohort study was conducted in Northern Denmark. We included 4389 hospitalized medical patients with positive blood cultures obtained on the day of admission. Patients hospitalized with bacteremia were matched with up to 10 general population controls and up to 5 acutely admitted nonbacteremic controls, matched on age, sex, and calendar time. All incident events of myocardial infarction and stroke during the following 365 days were ascertained from population-based healthcare databases. Multivariable regression analyses were used to assess relative risks with 95% confidence intervals (CIs) for myocardial infarction and stroke among bacteremia patients and their controls. The risk for myocardial infarction or stroke was greatly increased within 30 days of community-acquired bacteremia: 3.6% versus 0.2% among population controls (adjusted relative risk, 20.86; 95% CI, 15.38-28.29) and 1.7% among hospitalized controls (adjusted relative risk, 2.18; 95% CI, 1.80-2.65). The risks for myocardial infarction or stroke remained modestly increased from 31 to 180 days after bacteremia in comparison with population controls (adjusted hazard ratio, 1.64; 95% CI, 1.18-2.27), but not versus hospitalized controls (adjusted hazard ratio, 0.95; 95% CI, 0.69-1.32). No differences in cardiovascular risk were seen after >6 months. Increased 30-day risks were consistently found for a variety of etiologic agents and infectious foci. CONCLUSIONS: Community-acquired bacteremia is associated with increased short-term risk of myocardial infarction and stroke.

Dalager-Pedersen, Michael; Søgaard, Mette

2014-01-01

109

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)

Heart failure (HF) is one of the leading causes of hospitalization and death in United States and throughout Europe. While a higher risk of HF with antecedent myocardial infarction (MI) has been reported in offspring whose parents had MI before age 55, it is unclear whether adherence to healthful behaviors could mitigate that risk. The aim of the current 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. The information on parental history of MI and lifestyle factors was collected using questionnaires. Subjects adhering to at least three healthy lifestyle factors were classified as having good vs. poor lifestyle score. 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 score and no parental history of premature MI, multivariable adjusted hazard ratios (95% CI) for incident HF with antecedent MI was 3.21 (1.74–5.91) for people with good lifestyle score and parental history of premature MI; 1.52 (1.12–2.07) for individuals with poor lifestyle score and no parental history of premature MI; and 4.60 (2.55–8.30) for people with poor lifestyle score and parental history of premature MI. In conclusion, our data suggest that even in people at higher risk of HF due to genetic predisposition, adherence to healthful lifestyle factors may attenuate such an elevated HF risk.

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

2012-01-01

110

Ethnic group differences in cardiovascular risk assessment scores: national cross-sectional study.  

Science.gov (United States)

Objectives. There are marked inequalities in cardiovascular disease (CVD) incidence and outcomes between ethnic groups. CVD risk scores are increasingly used in preventive medicine and should aim to accurately reflect differences between ethnic groups. Ethnicity, as an independent risk factor for CVD, can be accounted for in CVD risk scores primarily using two methods, either directly incorporating it as a risk factor in the algorithm or through a post hoc adjustment of risk. We aim to compare these two methods in terms of their prediction of CVD across ethnic groups using representative national data from England. Design. A cross-sectional study using data from the Health Survey for England. We measured ethnic group differences in risk estimation between the QRISK2, which includes ethnicity and Joint British Societies 2 (JBS2) algorithm, which uses post hoc risk adjustment factor for South Asian men. Results. The QRISK2 score produces lower median estimates of CVD risk than JBS2 overall (6.6% [lower quartile-upper quartile (LQ-UQ) = 4.0-18.6] compared with 9.3% [LQ-UQ = 2.3-16.9]). Differences in median risk scores are significantly greater in South Asian men (7.5% [LQ-UQ = 3.6-12.5]) compared with White men (3.0% [LQ-UQ = 0.7-5.9]). Using QRISK2, 19.1% [95% confidence interval (CI) = 16.2-22.0] fewer South Asian men are designated at high risk compared with 8.8% (95% CI = 5.9-7.8) fewer in White men. Across all ethnic groups, women had a lower median QRISK2 score (0.72 [LQ-UQ = - 0.6 to 2.13]), although relatively more (2.0% [95% CI = 1.4-2.6]) were at high risk than with JBS2. Conclusions. Ethnicity is an important CVD risk factor. Current scoring tools used in the UK produce significantly different estimates of CVD risk within ethnic groups, particularly in South Asian men. Work to accurately estimate CVD risk in ethnic minority groups is important if CVD prevention programmes are to address health inequalities. PMID:23663041

Dalton, Andrew R H; Bottle, Alex; Soljak, Michael; Majeed, Azeem; Millett, Christopher

2014-08-01

111

Autoradiographic method for measuring the ischemic myocardium at risk: effects of verapamil on infarct size aftr experimental coronary artery occlusion.  

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Investigation of the efficacy of pharmacologic agents affecting myocardial infarct size after coronary artery occlusion is complicated by the variability of collateral flow among experimental animals which results in variability of infarct size. To overcome this difficulty, we developed an autoradiographic method to delineate the ischemic area at risk of necrosis after coronary artery occlusion and we invetigated the potential protective effect of a calcium antagonist verapamil. The left ante...

Deboer, L. W.; Strauss, H. W.; Kloner, R. A.; Rude, R. E.; Davis, R. F.; Maroko, P. R.; Braunwald, E.

1980-01-01

112

Assessment of Holter ST monitoring for risk stratification in patients with acute myocardial infarction treated by thrombolysis.  

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OBJECTIVES--To evaluate the role of Holter ST monitoring for identifying patients at risk of recurrent ischaemic events after acute myocardial infarction treated by thrombolysis. BACKGROUND--The natural history of myocardial infarction has changed with the introduction of thrombolytic treatment. There is now a lower mortality but a higher incidence of recurrent thrombotic events (reinfarction, unstable angina). Preliminary evidence indicates that Holter ST monitoring may be of prognostic valu...

Stevenson, R.; Ranjadayalan, K.; Wilkinson, P.; Marchant, B.; Timmis, A. D.

1993-01-01

113

Effect of antecedent hypertension and follow-up blood pressure on outcomes after high-risk myocardial infarction  

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The influence of blood pressure on outcomes after high-risk myocardial infarction is not well characterized. We studied the relationship between blood pressure and the risk of cardiovascular events in 14 703 patients with heart failure, left ventricular systolic dysfunction, or both after acute myocardial infarction in the Valsartan in Myocardial Infarction Trial. We assessed the relationship between antecedent hypertension and outcomes and the association between elevated (systolic: >140 mm Hg) or low blood pressure (systolic: <100 mm Hg) in 2 of 3 follow-up visits during the first 6 months and subsequent cardiovascular events over a median 24.7 months of follow-up. Antecedent hypertension independently increased the risk of heart failure (hazard ratio [HR]: 1.19; 95% CI: 1.08 to 1.32), stroke (HR: 1.27; 95% CI: 1.02 to 1.58), cardiovascular death (HR: 1.11; 95% CI: 1.01 to 1.22), and the composite of death, myocardial infarction, heart failure, stroke, or cardiac arrest (HR: 1.13; 95% CI: 1.06 to 1.21). While low blood pressure in the postmyocardial infarction period was associated with increased risk of adverse events, patients with elevated blood pressure (n=1226) were at significantly higher risk of stroke (adjusted HR: 1.64; 95% CI: 1.17 to 2.29) and combined cardiovascular events (adjusted HR: 1.14; 95% CI: 1.00 to 1.31). Six months after a high-risk myocardial infarction, elevated systolic blood pressure, a potentially modifiable risk factor, is associated with an increased risk of subsequent stroke and cardiovascular events. Whether aggressive antihypertensive treatment can reduce this risk remains unknown Udgivelsesdato: 2008/1

Thune, J.J.; Signorovitch, J.

2007-01-01

114

Risk factors for acute myocardial infarction in women: evidence from the Royal College of General Practitioners' oral contraception study.  

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To determine the pattern of risk factors for acute myocardial infarction associated solely with women a nested case-control study was carried out on cohort data collected during the Royal College of General Practitioners' oral contraception study. Smoking (adjusted relative risk 1.7 for light smokers and 4.3 for heavy smokers), hypertension (2.4), toxaemia of pregnancy (2.8), and diabetes mellitus (6.9) were associated with a significantly increased risk of myocardial infarction. There was no...

Croft, P.; Hannaford, P. C.

1989-01-01

115

External validation of Indian diabetes risk score in a rural community of central India  

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Full Text Available Aim: To find whether the individuals of 45 years and more of rural area who are in higher tertile of Indian Diabetes Risk Score i.e. of IDRS of >60 as compared to those who are in lower tertile i.e. of <30, have high frequency of hyperglycemia, impaired glucose tolerance, and manifest diabetes mellitus. Methods: A cross-sectional community based study. The study was conducted in three pre-identified villages. For all consenting and the eligible subjects, the medical student visited their house and the fasting capillary blood glucose was done by One touch blood glucose monitoring system. Four simple questions and one anthropometric measurement for waist circumference helped in deriving the information for Indian Diabetes Risk Score from the same subject. Results: The Indian Diabetes Risk Score (IDRS (consisting of the factors like age, abdominal obesity, physical inactivity and the family history which predicted diabetes mellitus in the subject, its sensitivity was 97.50% and specificity of 87.89% when the score of >/+ 60 was externally validated on our rural population. Conclusion: Our study demonstrated that the Indian Diabetes Risk Score (IDRS can be reliably applied as effective tool for the mass screening of diabetes in the community.

Bharati Taksande

2012-02-01

116

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

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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.

Parinaz Poursafa

2011-06-01

117

Risk Score Model for Predicting Sonographic Non-alcoholic Fatty Liver Disease in Children and Adolescents  

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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.

Sayed-Mohsen Hosseini

2011-06-01

118

Effect of ?-blockers on the risk of atrial fibrillation in patients with acute myocardial infarction  

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Full Text Available INTRODUCTION: Oral ?-blockers improve the prognosis of patients with acute myocardial infarction, while atrial fibrillation worsens the prognosis of this population. The reduction of atrial fibrillation incidence in patients treated with ?-blockers could at least in part explain the benefits of this drug. OBJECTIVE: To investigate the effect of ?-blockers on the incidence of atrial fibrillation in patients with acute myocardial infarction. METHODS: We analyzed 1401 patients with acute myocardial infarction and evaluated the occurrence or absence of atrial fibrillation, the use of oral ?-blockers and mortality during the first 24 hours. RESULTS: a The use of ?-blockers was inversely correlated with the presence of atrial fibrillation (? = 0.004; OR = 0.54. b Correlations with mortality were as follows: 31.5% in patients with atrial fibrillation, 9.2% in those without atrial fibrillation (? < 0.001; Odds Ratio = 4.52, and 17.5% in patients not treated with ?-blockers and 6.7% in those who received the drug (? < 0.001; OR = 0.34. c Adjusted Models: The presence of atrial fibrillation was independently correlated with mortality (OR = 2.48, ? = 0.002. The use of ?-blockers was inversely and independently correlated with mortality (OR = 0.53; ? = 0.002. The patients who used ?-blockers showed a lower risk of atrial fibrillation (OR = 0.59; ? = 0.029 in the adjusted model. CONCLUSION: The presence of atrial fibrillation and the absence of oral ?-blockers increased in-hospital mortality in patients with acute myocardial infarction. Oral ?-blockers reduced the incidence of atrial fibrillation, which might be at least partially responsible for the drug's benefit.

Antonio Eduardo Pesaro

2010-01-01

119

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

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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 th...

2012-01-01

120

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)

1981-01-01

 
 
 
 
121

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

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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.

Lindhardsen, Jesper; Ahlehoff, Ole

2011-01-01

122

Development of an Adverse Drug Reaction Risk Assessment Score among Hospitalized Patients with Chronic Kidney Disease  

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Background Adverse drug reactions (ADRs) represent a major burden on the healthcare system. Chronic kidney disease (CKD) patients are particularly vulnerable to ADRs because they are usually on multiple drug regimens, have multiple comorbidities, and because of alteration in their pharmacokinetics and pharmacodynamic parameters. Therefore, one step towards reducing this burden is to identify patients who are at increased risk of an ADR. Objective To develop a method of identifying CKD patients who are at increased risk for experiencing ADRs during hospitalisation. Materials and Methods Factors associated with ADRs were identified by using demographic, clinical and laboratory variables of patients with CKD stages 3 to 5 (estimated glomerular filtration rate, 10–59 ml/min/1.73 m2) who were admitted between January 1, 2012, and December 31, 2012, to the renal unit of Dubai Hospital. An ADR risk score was developed by constructing a series of logistic regression models. The overall model performance for sequential models was evaluated using Akaike Information Criterion for goodness of fit. Odd ratios of the variables retained in the best model were used to compute the risk scores. Results Of 512 patients (mean [SD] age, 60 [16] years), 62 (12.1%) experienced an ADR during their hospitalisation. An ADR risk score included age 65 years or more, female sex, conservatively managed end-stage renal disease, vascular disease, serum level of C-reactive protein more than 10 mg/L, serum level of albumin less than 3.5 g/dL, and the use of 8 medications or more during hospitalization. The C statistic, which assesses the ability of the risk score to predict ADRs, was 0.838; 95% CI, 0.784–0.892). Conclusion A score using routinely available patient data can be used to identify CKD patients who are at increased risk of ADRs.

Saheb Sharif-Askari, Fatemeh; Syed Sulaiman, Syed Azhar; Saheb Sharif-Askari, Narjes; Al Sayed Hussain, Ali

2014-01-01

123

Risk Score and Metastasectomy Independently Impact Prognosis in Patients with Recurrent Renal Cell Carcinoma  

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Purpose To evaluate the prognostic roles of metastasectomy and an established risk stratification system for patients experiencing a disease recurrence following nephrectomy for non-metastatic renal cell carcinoma (RCC). Methods A retrospective analysis was performed on 129 patients with localized RCC treated by partial or radical nephrectomy and subsequently diagnosed with disease recurrence. At the time of recurrence, a previously validated risk score based on Karnofsky performance status, interval from nephrectomy, and serum hemoglobin, calcium, and lactate dehydrogenase levels was used to categorize patients as favorable, intermediate, or poor-risk. Survival from recurrence was assessed based on risk categorization and metastasectomy Results Median time from nephrectomy to recurrence was 16 months. Median and two-year survival rates were strongly associated with the risk score (favorable-risk: 73 months and 81%; intermediate-risk: 28 months and 54%; poor-risk: 6 months and 11%; log-rank<0.001). Metastasectomy was performed in 44 patients (34%) and found to be of clinical benefit across the various risk categories (interaction analysis, p=0.8). On multivariate analysis, a better risk category (p<0.001) and undergoing a metastasectomy (p<0.001) were each independently associated with a more favorable survival and when combined provided six different risk categories with an estimated two-year survival ranging from 0 – 93%. Conclusions The clinical course for patients with an RCC recurrence following nephrectomy can be variable and is independently impacted by an objectively obtained risk score and whether the patient undergoes a metastasectomy.

Eggener, Scott E; Yossepowitch, Ofer; Kundu, Shilajit; Motzer, Robert J; Russo, Paul

2008-01-01

124

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

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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%

Sehestedt, Thomas; Jeppesen, Jørgen

2009-01-01

125

Oligoclonal bands and age at onset correlate with genetic risk score in multiple sclerosis  

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Background Many genetic risk variants are now well established in multiple sclerosis (MS), but the impact on clinical phenotypes is unclear. Objective To investigate the impact of established MS genetic risk variants on MS phenotypes, in well-characterized MS cohorts. Methods Norwegian MS patients (n = 639) and healthy controls (n = 530) were successfully genotyped for 61 established MS-associated single nucleotide polymorphisms (SNPs). Data including and excluding Major Histocompatibility Complex (MHC) markers were summed to a MS Genetic Burden (MSGB) score. Study replication was performed in a cohort of white American MS patients (n = 1997) and controls (n = 708). Results The total human leukocyte antigen (HLA) and the non-HLA MSGB scores were significantly higher in MS patients than in controls, in both cohorts (P << 10 ?22). MS patients, with and without cerebrospinal fluid (CSF) oligoclonal bands (OCBs), had a higher MSGB score than the controls; the OCB-positive patients had a slightly higher MSGB than the OCB-negative patients. An early age at symptom onset (AAO) also correlated with a higher MSGB score, in both cohorts. Conclusion The MSGB score was associated with specific clinical MS characteristics, such as OCBs and AAO. This study underlines the need for well-characterized, large cohorts of MS patients, and the usefulness of summarizing multiple genetic risk factors of modest effect size in genotype-phenotype analyses.

Harbo, Hanne F; Isobe, Noriko; Berg-Hansen, Pal; Bos, Steffan D; Caillier, Stacy J; Gustavsen, Marte W; Mero, Inger-Lise; Celius, Elisabeth Gulowsen; Hauser, Stephen L; Oksenberg, Jorge R; Gourraud, Pierre-Antoine

2014-01-01

126

Obstetrical complications and Apgar score in subjects at risk of psychosis.  

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The objective of the study was to identify associations between a history of obstetrical complications (OCs) and the future development of symptoms indicating risk of psychosis (At Risk Mental State - ARMS). The frequency of OCs was assessed in 66 ARMS subjects, 50 subjects with the first episode of schizophrenia (FES) and 50 healthy controls. Obstetrical data was obtained from medical documentation and evaluated with the Lewis and Murray Scale. Definite OCs, according to the Lewis and Murray Scale, occurred significantly more frequently in the ARMS group compared to the controls (?(2) = 7.79, p = 0.005; OR = 4.20, 95% CI = 1.46-12.11), as well as in the FES subjects compared to the controls (?(2) = 8.39, p = 0.004; OR = 4.64, 95% CI = 1.56-13.20). Apgar scores in the first (Apgar 1) and the fifth minute after birth (Apgar 5) were significantly lower in the FES subjects compared to the controls (for Apgar 1 score Z = 4.439, p < 0.0001; for Apgar 5 score Z = 5.250, p < 0.0001). The ARMS subjects demonstrated significantly lower Apgar 5 scores compared to the healthy controls (Z = 3.458, p = 0.0016). The results indicate that OCs and low Apgar 5 score should be considered important factors in identifying subjects at risk of developing psychosis. PMID:24157247

Kotlicka-Antczak, Magdalena; Pawe?czyk, Agnieszka; Rabe-Jab?o?ska, Jolanta; Smigielski, Janusz; Pawe?czyk, Tomasz

2014-01-01

127

Biomarkers in acute myocardial infarction  

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Full Text Available Abstract Myocardial infarction causes significant mortality and morbidity. Timely diagnosis allows clinicians to risk stratify their patients and select appropriate treatment. Biomarkers have been used to assist with timely diagnosis, while an increasing number of novel markers have been identified to predict outcome following an acute myocardial infarction or acute coronary syndrome. This may facilitate tailoring of appropriate therapy to high-risk patients. This review focuses on a variety of promising biomarkers which provide diagnostic and prognostic information. Heart-type Fatty Acid Binding Protein and copeptin in combination with cardiac troponin help diagnose myocardial infarction or acute coronary syndrome in the early hours following symptoms. An elevated N-Terminal Pro-B-type Natriuretic Peptide has been well validated to predict death and heart failure following a myocardial infarction. Similarly other biomarkers such as Mid-regional pro-Atrial Natriuretic Peptide, ST2, C-Terminal pro-endothelin 1, Mid-regional pro-Adrenomedullin and copeptin all provide incremental information in predicting death and heart failure. Growth differentiation factor-15 and high-sensitivity C-reactive protein predict death following an acute coronary syndrome. Pregnancy associated plasma protein A levels following chest pain predicts risk of myocardial infarction and revascularisation. Some biomarkers such as myeloperoxidase and high-sensitivity C-reactive protein in an apparently healthy population predicts risk of coronary disease and allows clinicians to initiate early preventative treatment. In addition to biomarkers, various well-validated scoring systems based on clinical characteristics are available to help clinicians predict mortality risk, such as the Thrombolysis In Myocardial Infarction score and Global Registry of Acute Coronary Events score. A multimarker approach incorporating biomarkers and clinical scores will increase the prognostic accuracy. However, it is important to note that only troponin has been used to direct therapeutic intervention and none of the new prognostic biomarkers have been tested and proven to alter outcome of therapeutic intervention. Novel biomarkers have improved prediction of outcome in acute myocardial infarction, but none have been demonstrated to alter the outcome of a particular therapy or management strategy. Randomised trials are urgently needed to address this translational gap before the use of novel biomarkers becomes common practice to facilitate tailored treatment following an acute coronary event.

Ng Leong L

2010-06-01

128

Chronic GVHD risk score: a Center for International Blood and Marrow Transplant Research analysis.  

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Several risk factors are associated with increased mortality in patients with chronic graft-versus-host disease (cGVHD), but there is considerable variability in the reported factors. Therefore, we evaluated patient, transplantation, and cGVHD characteristics to develop a risk score in 5343 patients with cGVHD. Ten variables were identified as being significant in multivariate analysis of overall survival and nonrelapse mortality (NRM): age, prior acute GVHD, time from transplantation to cGVHD, donor type, disease status at transplantation, GVHD prophylaxis, gender mismatch, serum bilirubin, Karnofsky score, and platelet count. These 10 variables were used to build a cGVHD risk score, and 6 risk groups (RGs) were identified. The 5-year NRM was 5% (1%-9%) in RG1, 20% (19%-23%) in RG2, 33% (29%-37%) in RG3, 43% (40%-46%) in RG4, 63% (53%-74%) in RG5, and 72% (59%-85%) in RG6. The 5-year overall survival was highest at 91% (95% confidence interval [CI]:85%-97%) in RG1, followed by 67% (65%-69%) in RG2, 51% (46%-55%) in RG3, 40% (37%-43%) in RG4, 21% (12%-30%) in RG5, and 4% (0%-9%) in RG6 (all P < .01). This analysis demonstrates the usefulness of data from a large registry to develop risk-score categories for major transplantation outcomes. Validation of this cGVHD risk score is needed in a different population to ensure its broad applicability. PMID:21493797

Arora, Mukta; Klein, John P; Weisdorf, Daniel J; Hassebroek, Anna; Flowers, Mary E D; Cutler, Corey S; Urbano-Ispizua, Alvaro; Antin, Joseph H; Bolwell, Brian J; Boyiadzis, Michael; Cahn, Jean-Yves; Cairo, Mitchell S; Isola, Luis; Jacobsohn, David A; Jagasia, Madan; Klumpp, Thomas R; Lee, Stephanie J; Petersdorf, Effie W; Santarone, Stella; Gale, Robert Peter; Schouten, Harry C; Spellman, Stephen; Wingard, John R; Horowitz, Mary M; Pavletic, Steven Z

2011-06-16

129

The Relationship of Gensini Score with the Cardiovascular Risk of Patients with Indication of Angiography  

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Full Text Available Background: This study was designed to explore the contribution of risk factors for coronary artery disease (CAD in patients with indication for coronary angiography. Coronary angiography is defined as the radiographic visualization of the coronary vessels after injection of radio opaque contrast media. Despite the recognition of risk factors for CAD, the association between related risk factors and angiographic findings remains controversial. The aim of the present study was to explore the association between Gensini scores and major cardiovascular risk factors in patients with indications for coronary angiography. Methods: We retrospectively enrolled 495 patients who had been hospitalized at Dr. Shariati Hospital during September 2009 to September 2010 and had undergone coronary angiography. The patients were evaluated for the severity of coronary lesions on the angiogram by Gensini scoring system. The patients were also evaluated for the presence or absence of DM, hypertension, family history of cardiac diseases, low HDL, hyperlipoproteinemia, hypertriglyceridemia and cigarette smoking. Statistical analysis wad done to find any relationship between Gensini scores and cardiovascular risk factors.Results: The study population consisted of 249 men (50.3% and 245 woman (49.5% with a mean age of 58.1±10.3 years. A positive correlation was found between age (P=0.04, sex (P=0.008, HDL (P=0.04 smoking (P=0.0001 and diabetes (P<0.013 with Gensini scores.Conclusion: In patients with indications of angiography, Gensini scores provide valuable prognostic information on cardiovascular risk factors. Age, sex, HDL, smoking and diabetes are related to the severity of coronary lesions on the angiograms.

Abbas Mohagheghi M.D.

2011-06-01

130

Chronic GVHD risk score: a Center for International Blood and Marrow Transplant Research analysis  

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Several risk factors are associated with increased mortality in patients with chronic graft-versus-host disease (cGVHD), but there is considerable variability in the reported factors. Therefore, we evaluated patient, transplantation, and cGVHD characteristics to develop a risk score in 5343 patients with cGVHD. Ten variables were identified as being significant in multivariate analysis of overall survival and nonrelapse mortality (NRM): age, prior acute GVHD, time from transplantation to cGVH...

Arora, Mukta; Klein, John P.; Weisdorf, Daniel J.; Hassebroek, Anna; Flowers, Mary E. D.; Cutler, Corey S.; Urbano-ispizua, Alvaro; Antin, Joseph H.; Bolwell, Brian J.; Boyiadzis, Michael; Cahn, Jean-yves; Cairo, Mitchell S.; Isola, Luis; Jacobsohn, David A.; Jagasia, Madan

2011-01-01

131

Performance of bleeding risk-prediction scores in patients with atrial fibrillation undergoing percutaneous coronary intervention.  

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The hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, and drugs/alcohol (HAS-BLED); anticoagulation and risk factors in atrial fibrillation (ATRIA); modified Outpatient Bleeding Risk Index (mOBRI); and reduction of atherothrombosis for continued health (REACH) schemes are validated bleeding risk-prediction tools, but their predictive performance in patients with AF receiving multiple antithrombotic drugs after percutaneous coronary intervention (PCI) is unknown. We sought to compare the predictive performance of bleeding risk-estimation tools in a cohort of patients with atrial fibrillation (AF) undergoing PCI. Management of patients with AF undergoing coronary artery stenting is a multicenter European prospective registry enrolling patients with AF undergoing PCI. We calculated HAS-BLED, ATRIA, mOBRI, and REACH bleeding risk-prediction scores and assessed the rate of bleeding complications as defined by Bleeding Academic Research Consortium at 12 months follow-up in 929 consecutive patients undergoing PCI. Increasing age, femoral access site, and previous peptic ulcer were independent determinants of bleeding. Low bleeding risk scores as determined by HAS-BLED 0 to 2, ATRIA 0 to 3, mOBRI 0, and REACH 0 to 10 were detected in 23.7%, 73.0%, 7.8%, and 5.7% of patients of the cohort, respectively. No significant differences were detected in the rates of any bleeding or major bleeding events for low versus intermediate/high scores with each risk-prediction tool. In conclusion, the performance of ATRIA, HAS-BLED, mOBRI, and REACH scores in predicting bleeding complications in this high-risk patient subset was useless. PMID:24793675

Kiviniemi, Tuomas; Puurunen, Marja; Schlitt, Axel; Rubboli, Andrea; Karjalainen, Pasi; Vikman, Saila; Niemelä, Matti; Lahtela, Heli; Lip, Gregory Y H; Airaksinen, K E Juhani

2014-06-15

132

Risk Factors of Reperfusion Failure following Primary Angioplasty for ST-Segment Elevation Myocardial Infarction (STEMI)  

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Background: Although percutaneous coronary intervention (PCI) improves outcomes compared to thrombolysis, a substantial number of ST-elevation myocardial infarction (STEMI) patients do not achieve optimal myocardial reperfusion. This study was designed to evaluate factors related to suboptimal myocardial reperfusion after primary PCI in patients with STEMI. Methods: Totally, 155 patients (124 men; mean age = 56.6 ± 11.03 years, range = 31– 85 years) with STEMI undergoing primary PCI were retrospectively studied. Additionally, the relationships between the occurrence of reperfusion failure and variables such as age, sex, cardiac risk factors, family history, Body Mass Index, time of symptom onset, ejection fraction, previous PCI, coronary artery bypass graft surgery or previous myocardial infarction, and angiographic data were analyzed. Results: Procedural success was 97.1% and complete ST resolution occurred in 43.2%. Age; cardiac risk factors; family history; body mass index; previous MI, coronary artery bypass graft surgery, or PCI; and use of thrombectomy device and GPIIb/IIIa inhibitor were not the determining factors (p value > 0.05). According to our multivariate analysis, time of symptom onset (OR [95% CI]: 045 [0.2 to 0.98]; p value = 0.044) and ejection fraction (OR [95% CI]:0.37 [0.26 to .091]; p value = 0.050) had reverse and male gender had direct significant associations with failed reperfusion (OR [95% CI]: 0.34 [0.11 to 1.08]; p value = 0.068). More degrees of ST resolution occurred when the right coronary artery was the culprit vessel (p value = 0.001). The presence of more than three cardiac risk factors was associated with failed reperfusion (p value = 0.050). Conclusion: Considering the initial risk profile of patients with acute STEMI, including time of symptom onset and ejection fraction, as well as the accumulation of cardiac risk factors in a given patient, we could predict failed myocardial reperfusion to design a more aggressive therapeutic strategy.

Sanati, Hamid Reza; Mahjoob, Mohammad Parsa; Zahedmehr, Ali; Ghahferokhi, Farshad Shakerian; Firoozi, Ata; Kiani, Reza; Sadeghi, Zohreh; Diz, Abolfath Alizadeh; Abkenar, Hooman Bakhshandeh

2013-01-01

133

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

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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 includ...

2007-01-01

134

Utility of framingham risk score in urban emergency department patients with asymptomatic hypertension.  

Science.gov (United States)

Hypertension (HTN) is the primary population-attributable risk for the development of heart failure (HF); a disease with devastating consequences particularly in urban centers where morbidity and mortality are more pronounced. The Framingham Risk Profile (FRP) is widely used to quantify risk for cardiovascular disease (CVD), but its applicability in an urban population who utilize the emergency department (ED) for primary care is unknown. The objective of this study is to evaluate FRP scores in ED patients with asymptomatic HTN and subclinical hypertensive heart disease (SHHD). This is a substudy of a prospective randomized clinical trial designed to evaluate optimal blood pressure (BP) targets. Eligible patients were screened with echocardiography for the presence of SHHD and FRP scores were calculated. One hundred forty-nine patients enrolled in the study, 133 (89.2%) of whom had detectable SHHD. Mean [SD] calculated FRP scores were statistically similar for patients with SHHD versus those without (general CVD: 20.2 [8.5] vs. 15.6 [8.7]; P = 0.13 and HF calibrated: 2.4 [1.0] vs. 1.8 [1.0]; P = 0.12) corresponding to a calculated risk of 15%-30% for subsequent development of CVD. The HF-specific risk score for patients with SHHD was 2.4, which equates to a 2.5% risk of HF development in 10 years. The FRP correctly identified those with SHHD as high-risk for general CVD but appeared to underestimate the likelihood of HF. Recalibration of the HF adjustment factor and inclusion of additional data elements such as echocardiography is needed to enhance applicability of the FRP in this setting. PMID:25062396

Brody, Aaron M; Flack, John M; Ference, Brian A; Levy, Phillip D

2014-09-01

135

Myocardial infarction in a low risk patient with hereditary hemorrhagic telangiectasia.  

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We describe the case of a 57 year-old woman with NSTE ACS, a history of recurrent and prolonged epistaxis, and low prior cardiovascular risk. Additional findings revealed anemia and an aneurysm in her central nervous system. During her hospital stay, hereditary hemorrhagic telangiectasia (HHT) was diagnosed. After application of two antiplatelet drugs, the patient was scheduled for coronarography, followed by coronary artery bypass grafting. During her hospital stay, only a minor episode of epistaxis was observed. We conclude that anemization due to HTT may significantly accelerate the progress of ischemic heart disease, resulting in acute coronary syndrome. Moreover, coronarography preceded by routine application of two antiplatelet drugs seems not to increase the risk of hemorrhage in HHT patients complicated with myocardial infarction. PMID:20544620

Janion, Marianna; Brzyzkiewicz, Halina; Siuda, Marcin; Domaga?a, Szymon; Karli?ski, Micha?

2010-01-01

136

The East London glaucoma prediction score:web-based validation of glaucoma risk screening tool  

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Full Text Available AIM:It is difficult for Optometrists and General Practitioners to know which patients are at risk. The East London glaucoma prediction score (ELGPS is a web based risk calculator that has been developed to determine Glaucoma risk at the time of screening. Multiple risk factors that are available in a low tech environment are assessed to provide a risk assessment. This is extremely useful in settings where access to specialist care is difficult. Use of the calculator is educational. It is a free web based service. Data capture is user specific.METHOD:The scoring system is a web based questionnaire that captures and subsequently calculates the relative risk for the presence of Glaucoma at the time of screening. Three categories of patient are described:Unlikely to have Glaucoma; Glaucoma Suspect and Glaucoma. A case review methodology of patients with known diagnosis is employed to validate the calculator risk assessment.RESULTS:Data from the patient records of 400 patients with an established diagnosis has been captured and used to validate the screening tool. The website reports that the calculated diagnosis correlates with the actual diagnosis 82% of the time. Biostatistics analysis showed:Sensitivity = 88%; Positive predictive value = 97%; Specificity = 75%.CONCLUSION:Analysis of the first 400 patients validates the web based screening tool as being a good method of screening for the at risk population. The validation is ongoing. The web based format will allow a more widespread recruitment for different geographic, population and personnel variables.

Cook Stephen

2013-02-01

137

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

DEFF Research Database (Denmark)

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 lipoproteinâ??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 1.54â??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 1.21â??1.45); this effect was further attenuated by other CVD risk factors and the RR was reduced to 1.17 (95% confidence interval 1.06â??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 1.01â??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.

Worm, Signe W; Kamara, David Alim

2011-01-01

138

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

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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.

HerbertFJelinek

2013-07-01

139

Computed tomography coronary artery calcium scoring: review of evidence base and cost-effectiveness in cardiovascular risk prediction.  

Science.gov (United States)

Cardiovascular risk factor-scoring algorithms may fall short in identifying asymptomatic individuals who will subsequently suffer a coronary event. It is generally thought that evaluation of the extent of the atherosclerotic plaque and total plaque burden can improve cardiovascular risk stratification. In the last decade, there has been an increasing interest in coronary calcium scoring by computed tomography. By determining the calcium score, an estimate of the total amount of coronary plaque is obtained. Numerous studies have shown that the calcium score predicts coronary heart disease. Recently, the calcium score was shown to improve risk stratification beyond cardiovascular risk factors, especially in those individuals deemed to be at intermediate risk. So far, only limited data exist on the cost-effectiveness of coronary calcium scoring in asymptomatic populations. PMID:22914123

Vliegenthart, Rozemarijn; Morris, Pamela B

2012-09-01

140

The framingham risk score, diet, and inflammatory markers in Korean men with metabolic syndrome  

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The Framingham risk score (FRS) has been used to assess the risk of a cardiovascular event and to identify patients for risk factor modifications. Therefore, the purpose of this study was to evaluate the relationship of the FRS with dietary intake and inflammatory biomarkers. We conducted a cross-sectional study of 180 men (49.2 ± 10.2 years) with MS. Serum levels of high sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and adiponectin were examined. Participants were asked to co...

2012-01-01

 
 
 
 
141

Changing Risk and Demographic Factors of Myocardial Infarction in A Decade (1371-1381 in Three University Hospital  

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Full Text Available Background: coronary artery disease (CAD is one of the most important causes of mortality around the world. The mortality rate in acute myocardial infarction is about 30%. CAD risk factors change with time and there are very few studies in this field in Iran. These changes may be due to bio-environmental conditions. In this study our objective was to track these changes during a ten years period. Methods: This study was done in three general hospitals of Tehran University of medical sciences on patients with first acute myocardial infarction (AMI in years 1371 and 1381. Demographic and specific data were obtained from patient data sheets. Comparison of means was done by t-test and prevalence of risk factors by chi-square test. Results: Two hundred fifty eight patients in 1371 and 289 patients in 1381 were admitted to three university hospitals due to acute myocardial infarction for the first time. The mean age of women with AMI decreased 4 years (P=0.022. No significant change was seen in other coronary risk factors. We also observed a significant increase in prevalence of myocardial infarction in women with three risk factors (P=0.01. Conclusion: We found no significant change in the age of male patients and in the CAD risk factors in 1371 and 1381. Mean age of occurrence of AMI in female shows a four-year decrease during this period. More studies are needed to find reasons for this change.

F. Soltanipoor

2006-07-01

142

Association of gene polymorphisms with myocardial infarction in individuals with or without conventional coronary risk factors.  

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The purpose of the present study was to assess the genetic risk for myocardial infarction (MI) in individuals with or without conventional coronary risk factors and thereby to contribute to the personalized prevention of MI in such individuals. The study population comprised 3483 unrelated Japanese individuals (1913 men, 1570 women). The 1192 subjects with MI (926 men, 266 women) and 2291 controls (987 men, 1304 women) either had or did not have conventional coronary risk factors, including hypertension, hypercholesterolemia, and diabetes mellitus. The genotypes for 164 polymorphisms of 137 candidate genes were determined by a method that combines the polymerase chain reaction and sequence-specific oligonucleotide probes with suspension array technology. Multivariable logistic regression analysis and a stepwise forward selection procedure revealed that nine different polymorphisms were significantly (PAKAP10, 11,496Gright curved arrow A of F7, and 46Cright curved arrow T of F12 in individuals without hypercholesterolemia; 2445Gright curved arrow A of FABP2 in diabetic individuals; and -108/3Gright curved arrow 4G of IPF1 in nondiabetic individuals. Polymorphisms associated with MI may thus differ among individuals with different conventional coronary risk factors. Stratification of subjects on the basis of such risk factors may thus be important in order to achieve personalized prevention of MI with the use of genetic information. PMID:17143557

Nishihama, Kohta; Yamada, Yoshiji; Matsuo, Hitoshi; Segawa, Tomonori; Watanabe, Sachiro; Kato, Kimihiko; Yajima, Kazuhiro; Hibino, Takeshi; Yokoi, Kiyoshi; Ichihara, Sahoko; Metoki, Norifumi; Yoshida, Hidemi; Satoh, Kei; Nozawa, Yoshinori

2007-01-01

143

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

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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

2000-01-01

144

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

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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.

DonaldEdmondson

2012-05-01

145

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  

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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).

Olesen, Jonas Bjerring; Abildstrøm, Steen Zabell

2011-01-01

146

Myocardial infarction in young adults-risk factors and pattern of coronary artery involvement  

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Background: Coronary artery disease (CAD) mostly occurs in persons older than 45 years of age. In India, CAD manifests almost a decade earlier than in Western countries. This study was done to study the risk factors and angiographic profile in young patients presenting with acute myocardial infarction (AMI). Patients and Methods: One hundred and twenty four consecutive patients presenting with AMI at less than 40 years of age were studied for risk factors. Coronary angiography was done in all. Results: Out of 124 patients, 123 were male. Mean age was 35.94 ± yrs. One hundred and eighteen had ST elevation myocardial infarction (MI) (95.16%) and six had non ST elevation MI (5.84%). Anterior wall MI was present in 88 patients (70.97%), inferior wall MI in 31 patients (25%) and lateral wall MI in five patients (4.03%). Seventy three patients (58.8%) were smoker, 55 were hypertensive (44.35%), 10 were diabetic (8.06%). Family history of CAD was present in 22 (17.7%) patients. Low High-density lipoprotein (HDL) was seen in 53 patients (42.7%), and high triglycerides in 60 patients (48.38%). Significant CAD was found in 88 (70.96%) patients, 13 (10.48%) had normal coronaries. Single vessel disease was seen in 57 patients, two-vessel disease in 15 patients and three-vessel disease in eight patients. Total 125 lesions were seen and left anterior descending (LAD) was the commonest vessel involved, with 78 lesions (62.4%). Conclusion: AMI in young almost exclusively occurs in male, and ST elevation MI is the main presentation. Anterior wall MI is most common, with LAD being involved in around 2/3 patients. Smoking, hypertension, low HDL and high triglycerides are the major risk factors.

Bhardwaj, Rajeev; Kandoria, Arvind; Sharma, Rajesh

2014-01-01

147

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

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Background 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. Objective To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. Methods 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. Results 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%). Conclusion 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.

Soares, Thays Soliman; Piovesan, Carla Haas; Gustavo, Andreia da Silva; Macagnan, Fabricio Edler; Bodanese, Luiz Carlos; Feoli, Ana Maria Pandolfo

2014-01-01

148

Frequency, clinical features and risk factors of lacunar infarction (data from a stroke registry in South India.  

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Full Text Available Analysis of 893 patients of ischaemic stroke in the stroke registry of Nizam?s institute of Medical Sciences, Hyderabad is presented. 16% of them had lacunar infarction. The mean age at presentation was 56.9 years and male to female ratio was 3.5:1. The common risk factors included hypertension(62%,diabetes(38% and smoking(28%. Six percent had an underlying cardiac source of embolism and none had significant (>50% extracranial carotid atherosclerosis. In 22% of patients, no obvious risk factors could be identified. The frequency of risk factors was similar in patients with lacunar and non- lacunar infarctions. However, patients with lacunar infarction had higher frequency of diabetes and absence of significant (>50% extracranial carotid artery disease. Pure motor hemiparesis was the presenting syndrome in 45% patients. Ataxic hemiparesis and sensorimotor stroke accounted for 18% each and dysarthria-clumsy hand syndrome for 14%. This study suggests that the frequency, risk factors and clinical profile of lacunar infarction in our stroke registry is similar to most of the western stroke registries.

Kaul S

2000-04-01

149

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

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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).

Nielsen, Michael René; Schmidt, Erik Berg

2013-01-01

150

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

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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

Boscarino JA

2013-04-01

151

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

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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

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

152

Risk factors for myocardial infarction among low socioeconomic status South Indian population  

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Full Text Available Abstract Background As longevity increases, cases of myocardial infarction (MI are likely to be more. Cardiovascular disease (CVD is a major global health problem reaching epidemic proportions in the Indian subcontinent, also among low socio-economic status (SES and thin individuals. Objectives The present study was undertaken to elicit risk factors for MI among low SES Southern Indians and to find out its association with body mass index (BMI. Materials and methods A case-control study of patients with MI matched against healthy control subjects was carried out in a tertiary care teaching hospital. Standard methods were followed to elicit risk factors and BMI. Chi-square and Fishers exact test for categorical versus categorical, to show relationship with risk factors were analyzed. Results A total of 949 patients (male (M = 692 and post menopausal female (F = 257 and 611 age and sex matched healthy controls were included. In our study, BMI was below 23 in 48.2% of patients and below 21 in 22.5%. The risk of developing MI was significantly more in males (odds ratio (OR = 3.3, 95% confidence interval (C.I. = 2.69-4.13, among females with post-menopausal duration (PMD of more than or equal to 3 years (OR = 9.27, 95% C.I. = 6.36-13.50 and in those with BMI less than 23 with one or other risk factors (P = 0.002, OR = 1.38, 95% C.I. = 1.13-1.70. Conclusion BMI cannot be considered as a lone independent risk factor, as the study population had low BMI but had one or more modifiable risk factors. It would be advisable to keep BMI at least 21 kg/m2 for screening program. Health education on life style modification and programs to diagnose and control diabetes and hypertension have to be initiated at community level in order to reduce the occurrence.

Meenakshisundaram Ramachandran

2010-05-01

153

[Association of rs966221 phosphodiesterase 4D gene's polymorphism with risk of myocardial infarction].  

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The aim of the paper was to study an association of rs966221 phosphodiesterase 4D (PDE4D) gene's polymorphism with risk of myocardial infarction (IM). One hundren sixty six persons were observed. The I (main) group included 97 patients with IM in anamnesis and the II (control) group consisted of 65 persons without IM. The study of polymorphism was performed by polymerase chain reaction with restriction of products. An increased frequency of TT genotype in the main group (20.6 %) comparing with controls (7.7 %; P = 0.026) was found. The differences were significant in men over 60 years old, having presence of arterial hypertension and signs of dyslipidemia. PMID:23786009

Pleskach, H V; Chumak, A A; Zelins'ka, A V; Shedenko, L I

2012-12-01

154

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

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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 ...

2011-01-01

155

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

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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 8...

2012-01-01

156

Dopamine Genetic Risk Score Predicts Depressive Symptoms in Healthy Adults and Adults with Depression  

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Background Depression is a common source of human disability for which etiologic insights remain limited. Although abnormalities of monoamine neurotransmission, including dopamine, are theorized to contribute to the pathophysiology of depression, evidence linking dopamine-related genes to depression has been mixed. The current study sought to address this knowledge-gap by examining whether the combined effect of dopamine polymorphisms was associated with depressive symptomatology in both healthy individuals and individuals with depression. Methods Data were drawn from three independent samples: (1) a discovery sample of healthy adult participants (n?=?273); (2) a replication sample of adults with depression (n?=?1,267); and (3) a replication sample of healthy adult participants (n?=?382). A genetic risk score was created by combining functional polymorphisms from five genes involved in synaptic dopamine availability (COMT and DAT) and dopamine receptor binding (DRD1, DRD2, DRD3). Results In the discovery sample, the genetic risk score was associated with depressive symptomatology (??=??0.80, p?=?0.003), with lower dopamine genetic risk scores (indicating lower dopaminergic neurotransmission) predicting higher levels of depression. This result was replicated with a similar genetic risk score based on imputed genetic data from adults with depression (??=??0.51, p?=?0.04). Results were of similar magnitude and in the expected direction in a cohort of healthy adult participants (??=??0.86, p?=?0.15). Conclusions Sequence variation in multiple genes regulating dopamine neurotransmission may influence depressive symptoms, in a manner that appears to be additive. Further studies are required to confirm the role of genetic variation in dopamine metabolism and depression.

Mortero, Sarah; Devan, William J.; Falcone, Guido J.; Lee, Phil; Holmes, Avram J.; Hollinshead, Marisa O.; Roffman, Joshua L.; Smoller, Jordan W.; Rosand, Jonathan; Cramer, Steven C.

2014-01-01

157

Histological scoring and associated risk factors of non-alcoholic fatty liver disease.  

Science.gov (United States)

Non alcoholic steatohepatitis is a hepatic disorder with histological features of alcohol induced liver disease that occurs in individual who do not consume significant alcohol. Liver biopsy is an important part of the evaluation in term of both grade & stage. A cross sectional study was carried out in the department of Pathology, Dhaka Medical College, Dhaka & department of Hepatology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2007 to June 2009. Total 55 adult subjects of both sex were included on the basis of predefined inclusion & exclusion criteria in this study to evaluate the histological pattern of non alcoholic fatty liver disease (NAFLD) and its correlation with risk factors. Liver biopsy was done and H & E and Masson's Trichrome stain slides were examined to evaluate the grade and stage of NAFLD. Scoring and semiquantitative assessment of steatosis and NAFLD severity was done according to Kleiner scale known as NAFLD activity score (NAS). The results of Pearson correlation showed only BMI and triglyceride level significantly correlated with NAS score. The results of Spearman's rank correlation showed that BMI, central obesity, triglyceridaemia and age significantly correlated with staging of fibrosis. The results of multiple regression analysis showed that variation of NAS depend on BMI and triglyceride level. The study also revealed that risk factors contributed about 29% risk for the occurrence of non alcoholic steatohepatitis. PMID:24292310

Majid, N; Ali, Z; Rahman, M R; Akhter, A; Rajib, R C; Ahmad, F; Sharmin, S; Akond, A K; Huq, N

2013-10-01

158

Spontaneous conus medullaris infarction in a 79 year-old female with cardiovascular risk factors: a case report  

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Objective: To detail the case of a 79 year-old female who presented with sudden bilateral neurological deficits of the lower extremities and was later diagnosed with non-traumatic conus medullaris infarction. The purpose of this case report is to inform primary contact practitioners of the presentation, diagnosis and the associated risk factors of this condition in order to facilitate prompt management. Clinical Features: Spinal cord infarction presenting as low back pain with a high degree of bilateral loss of motor strength, sensation and reflexes in the lower extremities and bowel/bladder dysfunction, in a patient with previous coronary artery bypass graft surgery and renal insufficiency. Intervention and Outcome: Referral to emergency within hours of symptom onset allowed for immediate assessment, management and relatively favourable partial recovery. Summary: Although rare, conus medullaris infarction is potentially devastating and requires an appropriate clinical index of suspicion for timely diagnosis, treatment and optimal neurological recovery.

Wong, Jessica J.; Dufton, John; Mior, Silvano A.

2012-01-01

159

Applicability of two international risk scores in cardiac surgery in a reference center in Brazil.  

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Background: The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe. Objective: 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). Methods: 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. Results: 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. Conclusion: Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery. PMID:25004415

Garofallo, Silvia Bueno; Machado, Daniel Pinheiro; Rodrigues, Clarissa Garcia; Bordim, Odemir; Kalil, Renato A K; Portal, Vera Lúcia

2014-07-01

160

Glyburide increases risk in patients with diabetes mellitus after emergent percutaneous intervention for myocardial infarction - A nationwide study  

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BACKGROUND: Sulfonylureas have been linked to an increased cardiovascular risk by inhibition of myocardial preconditioning. Whether individual sulfonylureas affect outcomes in diabetic patients after emergent percutaneous coronary intervention for myocardial infarction is unknown. METHODS: All Danish patients receiving glucose-lowering drugs admitted with myocardial infarction between 1997 and 2006 who underwent emergent percutaneous coronary intervention were identified from national registers. Multivariable Cox proportional hazards models were used to analyze the risk of cardiovascular mortality and morbidity associated with sulfonylureas. RESULTS: A total of 926 patients were included and 163 (17.6%) patients died during the first year of which 155 (16.7%) were cardiovascular deaths. The most common treatment was sulfonylureas which were received by 271 (29.3%) patients, and 129 (13.9%) received metformin. Cox proportional hazard regression analyses adjusted for age, sex, calendar year, comorbidity and concomitant pharmacotherapy showed an increased risk of cardiovascular mortality (hazard ratio [HR] 2.91, 95% confidence interval [CI] 1.26-6.72 ; p=0.012), cardiovascular mortality and nonfatal myocardial infarction (HR 2.69 , 95% CI 1.21-6.00; p=0.016), and all-cause mortality (HR 2.46, 95% CI 1.11-5.47; p=0.027), respectively, with glyburide compared to metformin. CONCLUSIONS: Glyburide is associated with increased cardiovascular mortality and morbidity in patients with diabetes mellitus undergoing emergent percutaneous coronary intervention after myocardial infarction. Early reperfusion therapy is the mainstay in modern treatment of myocardial infarction and the time may have come to discard glyburide in favour of sulfonylureas that do not appear to confer increased cardiovascular risk.

Jørgensen, C H; Gislason, G H

2011-01-01

 
 
 
 
161

A melanoma risk score in a Brazilian population Um escore de risco para melanoma em uma população brasileira  

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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 individu...

Lucio Bakos; Simeona Mastroeni; Renan Rangel Bonamigo; Franco Melchi; Paolo Pasquini; Cristina Fortes

2013-01-01

162

A modified EBMT risk score predicts the outcome of patients with acute myeloid leukemia receiving allogeneic stem cell transplants.  

Science.gov (United States)

The systematic and standardized pretransplant risk assessment represents an important tool to predict the outcome of patients undergoing allogeneic stem cell transplantation (alloSCT). To investigate the capacity of a modified European group for blood and marrow transplantation (mEBMT) risk score to predict the outcome of patients with acute myeloid leukemia (AML) receiving allogeneic stem cell transplants, we retrospectively analyzed 214 patients transplanted at our center between 1995 and 2008. Overall survival (OS) of the whole cohort at 1, 3, and 5?yr was 62%, 48%, and 45%, whereas the cumulative incidence of relapse or non-relapse mortality (NRM) was 26%, 33%, and 33% or 19%, 21%, and 22%. In univariate analysis, a higher mEBMT risk score was associated with an inferior OS ranging from 69% for patients with a score of 0/1 to 26% for patients with a score of 5/6 at 5?yr (P?score point. Likewise, a higher mEBMT risk score was associated with an increased incidence of relapse (P?=?0.049). Importantly, the prognostic value of the mEBMT risk score in terms of OS and relapse was maintained in multivariate analysis. Taken together, this indicates that a mEBMT risk score may be used to predict the outcome of patients with AML following alloSCT. PMID:21265883

Hemmati, Philipp G; Terwey, Theis H; le Coutre, Philipp; Vuong, Lam G; Massenkeil, Gero; Dörken, Bernd; Arnold, Renate

2011-04-01

163

Personalized cardiovascular risk management linking SCORE and behaviour change to Web-based education.  

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The PULSE (Personalization Using Linkages of SCORE and behaviour change readiness to web-based Education) project objectives are to generate and evaluate a web-based personalized educational intervention for the management of cardiovascular risk. The program is based on a patient profile generated by combining: (a) an electronic patient data capture template (DCT); (b) the Systematic COronary Risk Evaluation (SCORE) algorithm; and (c) a Stage of Change determination model. The DCT inherently contains a set of evidence-based parameters for patient description and disease evaluation. The patient's stage of behaviour change determines messages consistent with the individual's change processes, decisional balance, and self-efficacy. The interventions are designed to address both medical and psychosocial aspects of risk management and, as such, we combine staged lifestyle modification materials and non-staged messages based on Canadian clinical guidelines to motivate personal risk management. The personalization decision logic is represented in Medical Logic Modules implemented in Java. An intelligent interactive system generates the personally relevant materials and delivers the education to the patient via the Web. An evaluation study will be conducted to determine whether web-based personalized educational strategies exert favourable influence on patient's interest, knowledge, and perceived compliance to the suggested lifestyle modifications. PMID:17108531

Davis, Selena; Abidi, Syed Sibte Raza; Cox, Jafna

2006-01-01

164

Prognostic value of residual ischaemia assessed by exercise electrocardiography and dobutamine stress echocardiography in low-risk patients following acute myocardial infarction  

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Risk stratification after uncomplicated myocardial infarction is major clinical problem. In particular, the prognostic value of residual inducible ischaemia is still controversial. We compared the relative prognostic value of exercise ECG and dobutamine stress echocardiography performed in the early post-infarction period.

Bigi, Riccardo; Fiorentini, Cesare

1997-01-01

165

Obesity Phenotype and Coronary Heart Disease Risk as Estimated by the Framingham Risk Score  

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There are conflicting data as to whether general or abdominal obesity is a better predictor of cardiovascular risk. This cross-sectional study involved 4,573 subjects aged 30 to 74 yr who participated in the Fourth Korea National Health and Nutrition Examination Survey conducted in 2008. Obesity phenotype was classified by means of body mass index (BMI) and waist circumference (WC), and participants were categorized into 4 groups. Individuals' 10-yr risk of coronary heart diseases (CHD) was d...

Park, Yong Soon; Kim, Jun-su

2012-01-01

166

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

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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.

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

2011-01-01

167

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  

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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 cre...

Massaro, Ayrton R.; Sacco, Ralph L.; Milberto Scaff; Mohr, J. P.

2002-01-01

168

A clinical follow-up study on the risk of cerebral infarction in Chinese aging overweight and obese population.  

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Summary: The current studies have shown that overweight and obesity are possible risk factors for cerebral infarction, but variety of weight status in the role of the mechanism of cerebral infarction is not yet fully understood. In our research, a prospective cohort follow-up study of 8 years (2002-2009) was used to analyze the correlation of weight, cerebral infarction and other factors in 1170 Han retired employees from KaiLuan Group. The study included enrolling with questionnaire survey, medical examination, brain CT scan and so on, based on the changes in body mass index from the beginning to the end of the follow-up study, the subjects were divided into eight groups: stay normal weight group (n = 364), stay overweight group (n = 171), development from overweight into obesity group (n = 95), stay obesity group (n = 37), development from normal weight into overweight group (n = 365), development from normal weight into obesity group (n = 63), overweight improved group (n = 55) and obesity improved group (n = 20). We found that the incidence of cerebral infarction in the stay overweight group was higher than in the stay obese and stay normal weight groups (25.15%, 18.92%, 19.23%, P 0.05). The incidence of hypertension in the development of normal weight into obesity group and stay obesity group was higher than stay overweight group and stay normal weight group (63.49%, 56.76%, 48.54%, 36.54%, P < 0.05), while the aggregated incidence of risk factors in above mentioned four groups was 75%, 64%, 63%, 55% (P < 0.05), respectively. In logistic regression analysis of correlative factors to cerebral infarction, waist circumference in the last checkup, diabetes, development from normal weight to overweight status, etc were selected (P < 0.01), and odds ratio (OR) values were 0.98, 6.51, 4.13 (P < 0.05), respectively. The incidence of cerebral infarction in overweight improved and obesity improved groups were 29.09%, 45.00%, relative risk values were 1.51, 2.34, the aggregated incidence of risk factors were 48%, 65%. This study showed that Chinese aging population who has overweight with a significant overweight stable phase and with no overweight stable phase but progressing to obesity had different risks of diseases. The former was at high risk of cerebral infarction, the latter was susceptible to hypertension. In the aging population of overweight and obesity, the aggregated incidence of cerebral infarction related risk factors were significantly increased, and weight-loss treatment did not reduce the incidence of cerebral infarction. Thus, the aging patients with obesity should be actively treated to eliminate hypertension and other risk factors, rather than an appetite for weight-loss treatment.: PMID:24331007

Xiaodong, Yuan; Shujuan, Wang; Yaru, Xu; Jing, Li

2011-01-01

169

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

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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.

Milovanovi? Branislav

2006-01-01

170

Primeiro escore de risco inflamatório das endopróteses de aorta First inflammatory risk score for aortic endoprostheses  

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Full Text Available OBJETIVO: Propor um escore de risco inflamatório para tratamento endovascular dos aneurismas da aorta. MÉTODOS: Vinte e cinco pacientes foram seguidos do período pré-operatório até 3º mês de pós-operatório (1 hora, 6 horas, 24 horas, 48 horas, 7 dias, 1 mês, 2 meses e 3 meses. Variáveis inflamatórias avaliadas foram proteína C reativa, velocidade de hemossedimentação, interleucinas (IL-6, IL8, fator de necrose tumoral alfa, L-selectina, molécula de adesão intercelular (ICAM-1, transfusão de hemáceas, volume de cristalóide, volume de contraste, material da prótese, número de próteses, contagem total de leucócitos e linfócitos. O teste de Spearman apontou as variáveis candidatas ao maior risco inflamatório, segundo P OBJECTIVE: To purpose an inflammatory risk score for aortic aneurysm endovascular treatment. METHODS: Twenty-five patients were followed-up from preoperative period to third month postoperatively (1-hour, 6-hour, 24-hour, 48-hour, 7-day, 1-month, 2- month and 3month. Inflammatory variables were C-reactive protein, hemosedimentation velocity, interleukins (IL-6, IL-8, tumor necrosis factor-Alpha, L-selectin, intercellular adhesion molecule (ICAM-1, red blood cells transfusion, volume of crystalloid, volume of contrast, type of endoprosthesis, number of endoprostheses, total count of leukocytes and lymphocytes. Spearman test defined the variables considered as candidates to higher inflammatory risk based on P < 20%. Logistic regression defined the variables considered as selected for final score based on P < 10%. ROC curve analysis revealed the cut-off values for variables selected by logistic regression. RESULTS: Variables defined by Spearman test were: volume of crystalloid (P=0.04, type of endoprosthesis (P=0.04, volume of contrast (P=0.02, preoperative IL-8 (P = 0.10, 1 - month ICAM-1 (P=0.03 and 1-month L-selectin (P=0.06. Logistic regression revealed that volume of crystalloid and preoperative IL-8 values are relevant for composition of inflammatory risk score for aortic aneurysm endovascular treatment. Risk score would be divided into three categories (mild, moderate and severe based on numeric intervals of these two variables and the categories would be correlated to clinical findings. CONCLUSION: Volume of crystalloid and preoperative IL-8 are variables that might contribute to categorize inflammatory risk and thereby might play a prognostic role for aortic aneurysm endovascular treatment.

Edmo Atique Gabriel

2008-12-01

171

Risk factors for post-acute myocardial infarction depression in elderly  

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Full Text Available Objective: To determine risk factors for development of post-acute ST elevation myocardial infarction (STEMI depression in elderly. Material and Methods: We included 104 elderly patients diagnosed with STEMI. Clinical, lab and imagistic data was recorded in the first week after STEMI. Six months after STEMI patients were evaluated for the presence of depression. Results: Bivariate analysis showed statistically significant association between post-STEMI depression and sex, arterial hypertension, type 2 diabetes, socio-economic status, presence of family, left ventricular ejection fraction, Lown classification and HDL-cholesterol values. Multivariate analysis determined that following parameters increased the probability of onset of depression six months post-STEMI in elderly: sex (OR – 3.2, type 2 diabetes (OR – 2.6, poor socio-economic status (OR – 3.5 and absence of family (OR – 4.2. Conclusion: diabetes, precarious socio-economic status, absence of family and female sex were risk factors for post-STEMI depression.

Cristina Mo?u?an

2011-12-01

172

The LRP6 rs2302685 polymorphism is associated with increased risk of myocardial infarction  

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Background Abnormal lipids is one of the critical risk factors for myocardial infarction (MI), however the role of genetic variants in lipid metabolism-related genes on MI pathogenesis still requires further investigation. We herein genotyped three SNPs (LRP6 rs2302685, LDLRAP1 rs6687605, SOAT1 rs13306731) in lipid metabolism-related genes, aimed to shed light on the influence of these SNPs on individual susceptibility to MI. Methods Genotyping of the three SNPs (rs2302685, rs6687605 and rs13306731) was performed in 285 MI cases and 650 control subjects using polymerase chain reaction–ligation detection reaction (PCR–LDR) method. The association of these SNPs with MI and lipid profiles was performed with SPSS software. Results Multivariate logistic regression analysis showed that C allele (OR?=?1.62, P?=?0.039) and the combined CT/CC genotype (OR?=?1.67, P?=?0.035) of LRP6 rs2302685 were associated with increased MI risk, while the other two SNPs had no significant effect. Further stratified analysis uncovered a more evident association with MI risk among younger subjects (?60 years old). Fascinatingly, CT/CC genotype of rs2302685 conferred increased LDL-C levels compared to TT genotype (3.0 mmol/L vs 2.72 mmol/L) in younger subjects. Conclusions Our data provides the first evidence that LRP6 rs2302685 polymorphism is associated with an increased risk of MI in Chinese subjects, and the association is more evident among younger individuals, which probably due to the elevated LDL-C levels.

2014-01-01

173

Genetic Variation in ABCG1 and Risk of Myocardial Infarction and Ischemic Heart Disease  

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OBJECTIVE: ATP binding cassette transporter G1 (ABCG1) facilitates cholesterol efflux from macrophages to mature high-density lipoprotein particles. Whether genetic variation in ABCG1 affects risk of atherosclerosis in humans remains to be determined. METHODS AND RESULTS: We resequenced the core promoter and coding regions of ABCG1 in 380 individuals from the general population. Next, we genotyped 10 237 individuals from the Copenhagen City Heart Study for the identified variants and determined the effect on lipid and lipoprotein levels and on risk of myocardial infarction (MI) and ischemic heart disease (IHD). g.-376C>T, g.-311T>A, and Ser630Leu predicted risk of MI in the Copenhagen City Heart Study, with hazard ratios of 2.2 (95% confidence interval: 1.2-4.3), 1.7 (1.0-2.9), and 7.5 (1.9-30), respectively. These results were confirmed for g.-376C>T in a case-control study comprising 4983 independently ascertained IHD cases and 7489 controls. Expression levels of ABCG1 mRNA were decreased by approximately 40% in g.-376C>T heterozygotes versus noncarriers (probability values: 0.005-0.009). Finally, in vitro specificity protein 1 (Sp1) bound specifically to a putative Sp1 binding site at position -382 to -373 in the ABCG1 promoter, and the presence of the -376 T allele reduced binding and transactivation of the promoter by Sp1. CONCLUSIONS: This is the first report of a functional variant in ABCG1 that associates with increased risk of MI and IHD in the general population.

Schou, Jesper; Frikke-Schmidt, Ruth

2012-01-01

174

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

LENUS (Irish Health Repository)

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.

Zannad, Faiez

2012-04-01

175

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

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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

Patumanond J

2012-04-01

176

A simple score for rapid risk assessment of non-high-risk pulmonary embolism  

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We tested whether bedside testing for H-FABP is, alone or integrated in combination models, useful for rapid risk stratification of non-high-risk PE.We prospectively studied 136 normotensive patients with confirmed PE. H-FABP was determined using a qualitative bedside-test showing a positive result for plasma concentration >7 ng/ml.Overall, 11 patients (8.1 %) had an adverse 30-day outcome. Of 58 patients (42.6 %) with a positive H-FABP bedside-test, 9 (15.5 %) had an unfavourable course ...

Lankeit, Mareike; Friesen, Dietrich; Scha?fer, Katrin; Hasenfuß, Gerd; Konstantinides, Stavros; Dellas, Claudia

2012-01-01

177

Validation of the EBMT Risk Score for South Brazilian Patients Submitted to Allogeneic Hematopoietic Stem Cell Transplantation  

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Background. Allogeneic hematopoietic stem cell transplantation (HSCT) is still associated with a high transplant-related mortality rate. In 2009, the EBMT risk score was validated as a simple tool to predict the outcome after allogeneic HSCT for acquired hematological disorders. Objectives. The aim of this study was to validate the applicability of the EBMT risk score for allogeneic HSCT on South Brazilian patients. Methods. A retrospective observational study was performed based on patients' records and data base at Hospital de Clínicas de Porto Alegre, including all allogeneic transplants for malignant and severe aplastic anemia from 1994 to 2010. Patients were categorized according to EBMT risk score and overall survival (OS). Nonrelapse mortality (NRM) and relapse rate (RR) were analyzed. Results. There were 278 evaluable patients. OS, NRM, and RR at five years median followup were 48.7%, 40.7%, and 30.7%, respectively. The OS was 81.8% for risk score 0 and 0% for score 6 (P < 0.001), and NRM was 13.6% and 80% for risk scores 0 and 6, respectively (P = 0.001). Conclusion. The EBMT risk score can be utilized as a tool for clinical decision making before allogeneic HSCT for malignant hematological diseases and severe aplastic anemia at a single center in Brazil.

Pitombeira, Beatriz Stela; Amorin, Bruna; Valim, Vanessa; Laureano, Alvaro; Rigoni, Lisandra; Ottoni, Erica; Fisher, Gustavo; Daudt, Liane; Silla, Lucia

2013-01-01

178

Validation of the EBMT Risk Score for South Brazilian Patients Submitted to Allogeneic Hematopoietic Stem Cell Transplantation.  

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Background. Allogeneic hematopoietic stem cell transplantation (HSCT) is still associated with a high transplant-related mortality rate. In 2009, the EBMT risk score was validated as a simple tool to predict the outcome after allogeneic HSCT for acquired hematological disorders. Objectives. The aim of this study was to validate the applicability of the EBMT risk score for allogeneic HSCT on South Brazilian patients. Methods. A retrospective observational study was performed based on patients' records and data base at Hospital de Clínicas de Porto Alegre, including all allogeneic transplants for malignant and severe aplastic anemia from 1994 to 2010. Patients were categorized according to EBMT risk score and overall survival (OS). Nonrelapse mortality (NRM) and relapse rate (RR) were analyzed. Results. There were 278 evaluable patients. OS, NRM, and RR at five years median followup were 48.7%, 40.7%, and 30.7%, respectively. The OS was 81.8% for risk score 0 and 0% for score 6 (P < 0.001), and NRM was 13.6% and 80% for risk scores 0 and 6, respectively (P = 0.001). Conclusion. The EBMT risk score can be utilized as a tool for clinical decision making before allogeneic HSCT for malignant hematological diseases and severe aplastic anemia at a single center in Brazil. PMID:24416593

Pitombeira, Beatriz Stela; Paz, Alessandra; Pezzi, Annelise; Amorin, Bruna; Valim, Vanessa; Laureano, Alvaro; Wieck, Andrea; Rigoni, Lisandra; Ottoni, Erica; Fisher, Gustavo; Daudt, Liane; Silla, Lucia

2013-01-01

179

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

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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.

Kenneth Blum et al

2010-07-01

180

Expanding role of the Madras Diabetes Research Foundation - Indian Diabetes Risk Score in clinical practice  

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The Indian Diabetes Risk Score was initially developed by the Madras Diabetes Research Foundation (MDRF-IDRS) to help detect undiagnosed Type 2 diabetes (T2DM) in the community. Soon it was found that the MDRF-IDRS could also help to predict incident diabetes, metabolic syndrome, coronary artery disease (CAD), non-alcoholic fatty liver disease as well as sleep disorders in the community. It helps to differentiate T2DM from non-T2DM. Finally, it also helps to identify those with CAD, periphera...

2013-01-01

 
 
 
 
181

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  

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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.

Lønborg, Jacob Thomsen; Vejlstrup, Niels Grove

2014-01-01

182

Extreme lipoprotein(a) levels and risk of myocardial infarction in the general population : the Copenhagen City Heart Study  

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Elevated lipoprotein(a) levels are associated with myocardial infarction (MI) in some but not all studies. Limitations of previous studies include lack of risk estimates for extreme lipoprotein(a) levels, measurements in long-term frozen samples, no correction for regression dilution bias, and lack of absolute risk estimates in the general population. We tested the hypothesis that extreme lipoprotein(a) levels predict MI in the general population, measuring levels shortly after sampling, correcting for regression dilution bias, and calculating hazard ratios and absolute risk estimates.

Kamstrup, Pia R; Benn, Marianne

2008-01-01

183

Serum thiols and cardiovascular risk scores: a combined assessment of transsulfuration pathway components and substrate/product ratios  

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Background: Serum thiols have shown associations with surrogate markers of cardiovascular disease. However, little information is available on their combined association with validated cardiovascular risk scores for primary prevention at population level. We sought to determine whether individual serum thiol concentrations and substrate/product ratios within the transsulfuration pathway are independently associated with such scores.

2013-01-01

184

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

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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.

Nossent, Anne Yaël; Hansen, Jakob Liebe

2011-01-01

185

Hyperhomocysteinemia, a Risk Factor for Myocardial Infarction in Patients with Type-2 Diabetes in Southern Sindh, Pakistan  

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Hyperhomocysteinemia is a major risk factor for Myocardial Infarction (MI) in patients with type 2 diabetes, in general population of Pakistan. However, the role of increase plasma homocysteine level in the development of Coronary Heart Disease (CHD) in patients with type 2 diabetes is still unknown. Therefore this study was designed to determine the relation ship between plasma homocysteine level and the incidence of MI in patients with type 2 diabetes. The study group consists of 107 patien...

2009-01-01

186

Risk Factors for Premature Myocardial Infarction: A Matched Case-Control Study  

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Full Text Available

Background: Myocardial infarction in young age is increasing. Identifying risk factors could be important for health promotion. We studied classic atherosclerotic risk factors in premature myocardial infarction.

Methods: In this matched case-control study, which was conducted from 2005 to 2007 in Birjand County, the east of Iran, atherosclerotic risk factors (hypertension, family history of coronary artery diseases, obesity, diabetes mellitus, dyslipidemia of 98 patients affected by acute myocardial infarction aged under 50 years were compared with that of 98 healthy neighborhood controls.

Results: Mean levels of cholesterol, triglyceride, low-density lipoprotein, as well as systolic blood pressure and body mass index were significantly higher in cases than in controls. There was a positive association between coronary artery disease at younger age and dyslipidemia OR=2.8 [95% CI: 1.5, 5.2], smoking OR=6.4 [95% CI: 3.0, 13.5], systolic hypertension OR=3.1 [95% CI: 1.5, 6.3], family history of coronary artery diseases OR=10.9 [95% CI: 3.2, 37.9] and diabetes OR=2.5 [95% CI: 1.04, 6.2].

Conclusion: Smoking, systolic hypertension and dyslipidemia were the most common risk factors among patients with premature myocardial infarction.<

Seyed Ali Moezy

2011-07-01

187

Association of Relatives of Hemodialysis Patients with Metabolic Syndrome, Albuminuria and Framingham Risk Score  

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Background and Aim Metabolic syndrome (MetS), albuminuria, and the Framingham Risk Score (FRS) are significant predictors for cardiovascular disease (CVD). However, the relationship and clinical significance of these CVD predictors in individuals with a family history of end-stage renal disease (ESRD) are unclear. We investigated the association of relatives of hemodialysis (HD) patients with MetS, albuminuria, and the FRS. Methods One hundred and sixty-six relatives of HD patients and 374 age- and sex- matched community controls were enrolled. MetS was defined using the Adult Treatment Panel III for Asians. Albuminuria was defined as urine albumin-to-creatinine ratio ?30 mg/g. CVD risk was evaluated by the FRS. Results A significantly higher prevalence of MetS (19.9% vs. 12.5%, P?=?0.026), albuminuria (12.7% vs. 5.1%, P?=?0.002) and high FRS risk ?10% of 10-year risk (15.7% vs. 8.5%, P?=?0.013) was found in relatives of HD patients compared to their counterpart controls. In multivariate analysis, being relatives of HD patients (vs. controls) was an independent determinant for MetS (odds ratio [OR], 1.785; 95% confidence interval [CI], 1.045 to 3.050), albuminuria (OR, 2.891; 95% CI, 1.431 to 5.841), and high FRS risk (OR, 1.863; 95% CI, 1.015 to 3.418). Higher low-density lipoprotein cholesterol (OR, 1.034; 95% CI, 1.017 to 1.052) and betel nut chewing (OR, 13.994; 95% CI, 3.384 to 57.871) were independent determinants for having a high FRS risk in relatives of HD patients. Conclusions Being relatives of HD patients was independently associated with MetS, albuminuria and high FRS risk, suggesting family members of ESRD patients may have higher CVD risks through the interactions of renal risk factors. Proactive surveillance of these CVD predictors and preventive strategies should be targeted to this high-risk population.

Huang, Jiun-Chi; Chen, Szu-Chia; Lin, Ming-Yen; Chang, Jer-Ming; Hwang, Shang-Jyh; Tsai, Jer-Chia; Chen, Hung-Chun

2014-01-01

188

Markers of risk in young offspring with paternal history of myocardial infarction.  

Science.gov (United States)

Coronary heart disease clusters within families, but there may be several reasons for this phenomenon to occur. A possible way to elucidate this is to study biological relatives of affected individuals. The aim of our study was thus to compare a number of clinical, metabolic, clotting and immunologic factors between offspring with paternal history of premature myocardial infarction and controls and to propose a model which could safely allow to identify the high risk subgroup among them. Sixty-nine offspring of both sexes mean age 18.1 years old (cases) and thirty-two frequency matched relative to age and gender controls were studied. Cases compared to controls had significantly increased diastolic blood pressure levels (74.0+/-9.9 vs. 67.4+/-8.3 mmHg, P=0.002), leptin plasma levels (11.8+/-10.8 vs. 6.8+/-3 ng/ml, P=0.046) and fibrinogen, plasminogen, fibrin degradation products and plasminogen activator inhibitor-1 plasma levels (306.6+/-52.5 vs. 280.6+/-28.9 mg%, P=0.03, 97.4+/-23.5 vs. 83.6+/-15 mg%, P=0.0007, 292.0+/-148.5 vs. 219.2+/-69.4 ng/ml, P=0.036, 14.7+/-5.3 vs. 8.7+/-3.1 I.U./ml, P=0.0001, respectively), while cases had significantly decreased HDL-cholesterol serum levels (45.9+/-12.5 vs. 50.5+/-8.8 mg%, P=0.03) and protein S plasma levels (89.9+/-17.5 vs. 101.3+/-13.7%, P=0.001). Our findings suggest that offspring of affected individuals may be considered as a high risk group for cardiovascular disease. PMID:12767554

Makris, Thomas K; Hatzizacharias, Antonios N; Krespi, Panagiota G; Chronakis, Emmanuel V; Vythoulkas, John S; Maria, Kouli; Tsoukala, Caterina G; Votteas, Vassilios V

2003-06-01

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Hormone Replacement Therapy and Risk of New-Onset Atrial Fibrillation after Myocardial Infarction - A Nationwide Cohort Study  

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Objectives Our aim was to assess the association between use of hormone replacement therapy (HRT) and risk of new-onset atrial fibrillation (AF) after myocardial infarction. Design, Setting and Participants We used Danish nationwide registers of hospitalizations and prescriptions to identify all women admitted with myocardial infarction in the period 1997 to 2009 and with no known diagnosis of AF. Their use of overall HRT and HRT categories was assessed. Multivariable Cox proportional hazards analysis was used to calculate the risk of new-onset AF first year after discharge, comparing use of HRT to no use. Main Outcome Measures New-onset atrial fibrillation. Results In the period 1997 to 2009, 32 925 women were discharged alive after MI. In the first year after MI, new-onset AF was diagnosed in 1381 women (4.2%). Unadjusted incidence rates of AF decreased with use of HRT (incidence rate 37.4 for use of overall HRT and 53.7 for no use). Overall HRT was associated with a decreased risk of AF (HR 0.82, 95% confidence interval [CI] 0.68–1.00). The lowest risk of AF was found in women ?80 years old for use of overall HRT and vaginal estrogen (HR 0.63, CI 0.42–0.94, and HR 0.58, CI 0.34–0.99, respectively). Decreased risk of AF with use of overall HRT and HRT categories was also found in other age groups. Conclusions Use of HRT is associated with a decreased risk of new-onset AF in women with myocardial infarction first year after discharge. The underlying mechanisms remain to be determined. Unmeasured confounding might be one of them.

Bretler, Ditte-Marie; Hansen, Peter Riis; Lindhardsen, Jesper; Ahlehoff, Ole; Andersson, Charlotte; Jensen, Thomas Bo; Rauns?, Jakob; Torp-Pedersen, Christian; Gislason, Gunnar Hilmar

2012-01-01

190

EBMT risk score predicts outcome of allogeneic hematopoietic stem cell transplantation in patients who have failed a previous transplantation procedure.  

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Increasing numbers of allogeneic hematopoietic stem cell transplantation (allo-SCT) are being performed for patients who have failed a previous allogeneic or autologous SCT. We investigated whether the EBMT risk score could predict outcome after a subsequent allo-SCT. We analyzed prognostic factors in 124 consecutive patients who underwent a second transplantation using an allogeneic donor at our institution. Patients with either a first autologous (N = 64) or first allogeneic (N = 60) SCT were included. Age, disease stage, time interval from diagnosis to transplantation, donor type, and donor-recipient sex combination were used to establish a score from 0 to 7 points, from which 3 groups were identified. The 5-year survival probability decreased from 51.7% for risk scores 0-3 (low, n = 25), to 29.3% for risk score 4 (intermediate, n = 42), and only 10.4% for risk scores 5-7 (high, n = 57), P = .001. We propose that the EBMT risk score can identify patients most likely to benefit from a second transplantation. PMID:21723225

Rezvani, Katayoun; Kanfer, Edward J; Marin, David; Gabriel, Ian; Rahemtulla, Amin; Taylor, Alexandra; Macdonald, Donald; Dazzi, Francesco; Milojkovic, Dragana; Foroni, Letizia; Pavlu, Jiri; Sargent, Jeremy; Le Dieu, Rifca; Goldman, John M; Apperley, Jane; Szydlo, Richard

2012-02-01

191

An obesity genetic risk score is associated with metabolic syndrome in Chinese children.  

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Recent genome-wide association studies have identified several single nucleotide polymorphisms (SNPs) associated with body mass index (BMI)/obesity. In this study, we aim to examine the associations of obesity related loci with risk of metabolic syndrome (MetS) in a children population from China. A total of 431 children with MetS and 3046 controls were identified based on the modified ATPIII definition. 11 SNPs (FTO rs9939609, MC4R rs17782313, GNPDA2 rs10938397, BDNF rs6265, FAIM2 rs7138803, NPC1 rs1805081, SEC16B rs10913469, SH2B1 rs4788102, PCSK1rs6235, KCTD15 rs29941, BAT2 rs2844479) were genotyped by TaqMan 7900. Of 11 SNPs, GNPDA2 rs10938397, BDNF rs6265, and FAIM2 rs7138803 were nominally associated with risk of MetS (GNPDA2 rs10938397: odds ratio (OR)=1.21, 95% confidence interval (CI)=1.04-1.40, P=0.016; BDNF rs6265: OR=1.19, 95% CI=1.03-1.39, P=0.021; FAIM2 rs7138803: OR=1.20, 95% CI=1.02-1.40, P=0.025); genetic risk score (GRS) was significantly associated with risk of MetS (OR=1.09, 95% CI=1.04-1.15, P=5.26×10(-4)). After further adjustment for BMI, none of SNPs were associated with risk of MetS (all P>0.05); the association between GRS and risk of MetS remained nominally (OR=1.02, 95%CI=0.96-1.08, P=0.557). However, after correction for multiple testing, only GRS was statistically associated with risk of MetS in the model without adjustment for BMI. The present study demonstrated that there were nominal associations of GNPDA2 rs10938397, BDNF rs6265, and FAIM2 rs7138803 with risk of MetS. The SNPs in combination have a significant effect on risk of MetS among Chinese children. These associations above were mediated by adiposity. PMID:24269186

Zhao, Xiaoyuan; Xi, Bo; Shen, Yue; Wu, Lijun; Hou, Dongqing; Cheng, Hong; Mi, Jie

2014-02-10

192

Electro-mechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging  

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To investigate whether grid-tag myocardial strain evaluation can characterise 'border-zone' peri-infarct region and identify patients at risk of ventricular arrhythmia as the peri-infarct myocardial zone may represent an important contributor to ventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). Forty-five patients with STEMI underwent cardiac magnetic resonance (CMR) imaging on days 3 and 90 following primary percutaneous coronary intervention (PCI). Circumferential peak circumferential systolic strain (CS) and strain rate (CSR) were calculated from grid-tagged images. Myocardial segments were classified into 'infarct', 'border-zone', 'adjacent' and 'remote' regions by late-gadolinium enhancement distribution. The relationship between CS and CSR and these distinct myocardial regions was assessed. Ambulatory Holter monitoring was performed 14 days post myocardial infarction (MI) to estimate ventricular arrhythmia risk via evaluation of heart-rate variability (HRV). We analysed 1,222 myocardial segments. Remote and adjacent regions had near-normal parameters of CS and CSR. Border-zone regions had intermediate CS (-9.0 {+-} 4.6 vs -5.9 {+-} 7.4, P < 0.001) and CSR (-86.4 {+-} 33.3 vs -73.5 {+-} 51.4, P < 0.001) severity compared with infarct regions. Patients with 'border-zone' peri-infarct regions had reduced very-low-frequency power on HRV analysis, which is a surrogate for ventricular arrhythmia risk (P = 0.03). Grid-tagged CMR-derived myocardial strain accurately characterises the mechanical characteristics of 'border-zone' peri-infarct region. Presence of 'border-zone' peri-infarct region correlated with a surrogate marker of heightened arrhythmia risk following STEMI. (orig.)

Wong, Dennis T.L.; Weightman, Michael J.; Baumert, Mathias; Tayeb, Hussam; Richardson, James D.; Puri, Rishi; Bertaso, Angela G.; Roberts-Thomson, Kurt C.; Sanders, Prashanthan; Worthley, Matthew I. [University of Adelaide, Cardiovascular Research Centre, Royal Adelaide Hospital and Discipline of Medicine, SA (Australia); Worthley, Stephen G. [University of Adelaide, Cardiovascular Research Centre, Royal Adelaide Hospital and Discipline of Medicine, SA (Australia); Royal Adelaide Hospital, Cardiovascular Investigational Unit, SA (Australia)

2012-08-15

193

Electro-mechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging  

International Nuclear Information System (INIS)

To investigate whether grid-tag myocardial strain evaluation can characterise 'border-zone' peri-infarct region and identify patients at risk of ventricular arrhythmia as the peri-infarct myocardial zone may represent an important contributor to ventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). Forty-five patients with STEMI underwent cardiac magnetic resonance (CMR) imaging on days 3 and 90 following primary percutaneous coronary intervention (PCI). Circumferential peak circumferential systolic strain (CS) and strain rate (CSR) were calculated from grid-tagged images. Myocardial segments were classified into 'infarct', 'border-zone', 'adjacent' and 'remote' regions by late-gadolinium enhancement distribution. The relationship between CS and CSR and these distinct myocardial regions was assessed. Ambulatory Holter monitoring was performed 14 days post myocardial infarction (MI) to estimate ventricular arrhythmia risk via evaluation of heart-rate variability (HRV). We analysed 1,222 myocardial segments. Remote and adjacent regions had near-normal parameters of CS and CSR. Border-zone regions had intermediate CS (-9.0 ± 4.6 vs -5.9 ± 7.4, P < 0.001) and CSR (-86.4 ± 33.3 vs -73.5 ± 51.4, P < 0.001) severity compared with infarct regions. Patients with 'border-zone' peri-infarct regions had reduced very-low-frequency power on HRV analysis, which is a surrogate for ventricular arrhythmia risk (P = 0.03). Grid-tagged CMR-derived myocardial strain accurately characterises the mechanical characteristics of 'border-zone' peri-infarct region. Presence of 'border-zone' peri-infarct region correlated with a surrogate marker of heightened arrhythmia risk following STEMI. (orig.)

2012-08-01

194

A risk score for identifying methicillin-resistant Staphylococcus aureus in patients presenting to the hospital with pneumonia.  

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BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) represents an important pathogen in healthcare-associated pneumonia (HCAP). The concept of HCAP, though, may not perform well as a screening test for MRSA and can lead to overuse of antibiotics. We developed a risk score to identify patients presenting to the hospital with pneumonia unlikely to have MRSA. METHODS: We identified patients admitted with pneumonia (Apr 2005 -- Mar 2009) at 62 hospitals in the US. We only included patients with lab evidence of bacterial infection (e.g., positive respiratory secretions, blood, or pleural cultures or urinary antigen testing). We determined variables independently associated with the presence of MRSA based on logistic regression (two-thirds of cohort) and developed a risk prediction model based on these factors. We validated the model in the remaining population. RESULTS: The cohort included 5975 patients and MRSA was identified in 14%. The final risk score consisted of eight variables and a potential total score of 10. Points were assigned as follows: two for recent hospitalization or ICU admission; one each for age 79 years, prior IV antibiotic exposure, dementia, cerebrovascular disease, female with diabetes, or recent exposure to a nursing home/long term acute care facility/skilled nursing facility. This study shows how the prevalence of MRSA rose with increasing score after stratifying the scores into Low (0 to 1 points), Medium (2 to 5 points) and High (6 or more points) risk. When the score was 0 or 1, the prevalence of MRSA was 30% when the score was 6 or greater. CONCLUSIONS: MRSA represents a cause of pneumonia presenting to the hospital. This simple risk score identifies patients at low risk for MRSA and in whom anti-MRSA therapy might be withheld. PMID:23742753

Shorr, Andrew F; Myers, Daniela E; Huang, David B; Nathanson, Brian H; Emons, Matthew F; Kollef, Marin H

2013-06-01

195

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

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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.

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

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Demographic determinants of risk, colon distribution and density scores of diverticular disease  

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Full Text Available AIM: To investigate associations between ethni95% CIty, age and sex and the risk, colon distribution and density scores of diverticular disease (DD.METHODS: Barium enemas were examined in 1000 patients: 410 male, 590 female; 760 whites, 62 Asians, 44 black africans (BAs, and 134 other blacks (OBs. Risks and diverticula density of left-sided DD (LSDD and right-sided-component DD (RSCDD = right-sided DD + right and left DD + Pan-DD were compared using logistic regression.RESULTS: Four hundred and forty-seven patients had DD (322 LSDD and 125 RSCDD. Adjusted risks: (1 LSDD: each year increase in age increased the odds by 6% (95% CI: 5-8, SE: 0.8%, P < 0.001; Asians: odds ratio (OR: 0.23 (95% CI: 0.10-0.53, SE: 0.1, P ? 0.001 and OBs: OR: 0.25 (95% CI: 0.14-0.43, SE: 0.07, P ? 0.001 appeared protected vs Whites; (2 RSCDD: each year increase in age increased the odds by 4% (95% CI: 2-6, SE: 1%, P < 0.001; females were 0.60 times (95% CI: 0.40-0.90, SE: 0.12, P = 0.01 less likely than males to have RSCDD; BAs were 3.51 times (95% CI: 1.70-7.24, SE: 1.30, P < 0.001 more likely than Whites to have RSCDD; and (3 DD density scores: each year increase in age increased the odds of high-density scores by 4% (95% CI: 1-6, SE: 1%, P < 0.001; RSCDD was 2.77 times (95% CI: 1.39-3.32, SE: 0.67, P < 0.001 more likely to be of high density than LSDD. No further significant differences were found in the adjusted models.CONCLUSION: Right colonic DD might be more common and has higher diverticula density in the west than previously reported. BAs appear predisposed to DD, whereas other ethnic differences appear conserved following migration.

Mark Golder, Irina Chis Ster, Pratusha Babu, Amita Sharma, Muhammad Bayat, Abdulkadir Farah

2011-02-01

197

Should clinicians use average or peak scores on a dynamic risk-assessment measure to most accurately predict inpatient aggression?  

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Recent advancements in risk assessment have led to the development of dynamic risk-assessment measures that are predictive of inpatient aggression in the short term. However, there are several areas within this field that warrant further empirical investigation, including whether the average, maximum, or most recent risk state assessment is the most valid for predicting subsequent aggression in the medium term. This prospective study compared the predictive validity of three indices (i.e. mean score, peak score, and most recent single time-point rating) of the Dynamic Appraisal of Situational Aggression (DASA) for inpatient aggression. Daily risk ratings were completed for 60 psychiatric inpatients (from the acute wards of a forensic psychiatric hospital) for up to 6 months; a total of 1054 DASA ratings were obtained. Results showed that mean and peak scores on the DASA were better predictors of interpersonal violence, verbal threat, and any inpatient aggression than the DASA single time-point most recent ratings. Overall, the results support the use of the prior week's mean and peak scores to aid the prediction of inpatient aggression within inpatient forensic psychiatric settings in the short to medium term. These results also have practical implications for clinicians considering risk-management strategies and the scoring of clinically-relevant items on risk-assessment measures. PMID:23211005

Chu, Chi Meng; Thomas, Stuart D M; Daffern, Michael; Ogloff, James R P

2013-12-01

198

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

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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…

Maxwell, June B.

2010-01-01

199

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

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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

Salameh P

2012-09-01

200

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

1986-01-01

 
 
 
 
201

Biomonitoring of pesticides by pine needles--chemical scoring, risk of exposure, levels and trends.  

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Vegetation is a useful matrix for the quantification of atmospheric pollutants such as semi-volatile organic compounds (SVOCs). In particular, pine needles stand out as effective biomonitors due to the excellent uptake properties of their waxy layer. Having previously validated an original and reliable method to analyse pesticides in pine needles, our work team set the objective of this study to determine the levels of 18 pesticides in Pinus pinea needles collected in 12 different sampling sites in Portugal. These compounds were selected among a total of 70 pesticides by previous chemical scoring, developed to assess their probability to occur in the atmosphere. The risk of exposure was evaluated by the binomial chemical score/frequency of occurrence in the analysed samples. Levels and trends of the chemical families and target of the pesticides were obtained regarding the type of land occupation of the selected sites, including the use of advanced statistics (principal component analysis, PCA). Finally, some correlations with several characteristics of the sampling sites (population, energy consumption, meteorology, etc.) were also investigated. PMID:24463249

Ratola, Nuno; Homem, Vera; Silva, José Avelino; Araújo, Rita; Amigo, José Manuel; Santos, Lúcia; Alves, Arminda

2014-04-01

202

Expanding role of the Madras Diabetes Research Foundation - Indian Diabetes Risk Score in clinical practice.  

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The Indian Diabetes Risk Score was initially developed by the Madras Diabetes Research Foundation (MDRF-IDRS) to help detect undiagnosed Type 2 diabetes (T2DM) in the community. Soon it was found that the MDRF-IDRS could also help to predict incident diabetes, metabolic syndrome, coronary artery disease (CAD), non-alcoholic fatty liver disease as well as sleep disorders in the community. It helps to differentiate T2DM from non-T2DM. Finally, it also helps to identify those with CAD, peripheral vascular disease and neuropathy among those with T2DM. Thus, the MDRF-IDRS is a simple, virtually 'no cost' tool which is useful in several clinical and epidemiological settings. PMID:23776850

Mohan, Viswanathan; Anbalagan, Viknesh Prabu

2013-01-01

203

Coronary artery disease from a perspective of genomic risk score, ethical approaches and suggestions  

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Full Text Available As a leading cause of mortality, coronary artery disease is on the focus of genetic research as a complex trait. Although predictive genetic testing for cardiovascular diseases is on the counter, it is still hard to aggregate information from multiple genetic variants, environmental factors and family history into a single score. Every susceptibility allele provides small contribution to disease formation. Biomarkers play a role in various metabolic pathways. Genetic information and data depend heavily on probabilities. This should be clearly explained by genetic counselor to the patient and relatives who are looking for certain answers. Presence of susceptibility alleles can be a source of anxiety and it may result as a reduced self-confidence in ability to change health behavior. Complex diseases set a new stage to study novel techniques that can elucidate interactions among genetic, environmental and ethnic factors. The cookbook approach to treat a complex disease can often be misleading. Future studies may provide personalized information, which can improve the outcome of standardized treatments. As knowing one’s own genetic risk is becoming a task for the responsible individual, it surely will add new challenges to ethical framework. Publicly marketing genetic tests for complex diseases raises ethical concerns. To avoid discriminatory use of genetic information; genetic risk scoring, therapeutic process, ethical policies must have a multifaceted progress. In this review, we summarized the attempts to resolve ethical issues related to genetic testing in complex diseases to resolve patient autonomy with individual responsibility and to aim the patient beneficence and confidentiality.

Ye?im I??l Ülman

2012-02-01

204

Seed Implant Retention Score Predicts the Risk of Prolonged Urinary Retention After Prostate Brachytherapy  

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Purpose: To risk-stratify patients for urinary retention after prostate brachytherapy according to a novel seed implant retention score (SIRS). Patients and Methods: A total of 835 patients underwent transperineal prostate seed implant from March 1993 to January 2007; 197 patients had 125I and 638 patients had 103Pd brachytherapy. Four hundred ninety-four patients had supplemental external-beam radiation. The final downsized prostate volume was used for the 424 patients who had neoadjuvant hormone therapy. Retention was defined as reinsertion of a Foley catheter after the implant. Results: Retention developed in 7.4% of patients, with an average duration of 6.7 weeks. On univariate analysis, implant without supplemental external-beam radiation (10% vs. 5.6%; p = 0.02), neoadjuvant hormone therapy (9.4% vs. 5.4%; p = 0.02), baseline ?-blocker use (12.5% vs. 6.3%; p = 0.008), and increased prostate volume (13.4% vs. 6.9% vs. 2.9%, >45 cm3, 25-45 cm3, 3; p = 0.0008) were significantly correlated with increased rates of retention. On multivariate analysis, implant without supplemental external-beam radiation, neoadjuvant hormone therapy, baseline ?-blocker use, and increased prostate volume were correlated with retention. A novel SIRS was modeled as the combined score of these factors, ranging from 0 to 5. There was a significant correlation between the SIRS and retention (p < 0.0001). The rates of retention were 0, 4%, 5.6%, 9%, 20.9%, and 36.4% for SIRS of 0 to 5, respectively. Conclusions: The SIRS may identify patients who are at high risk for prolonged retention after prostate brachytherapy. A prospective validation study of the SIRS is planned.

2010-04-01

205

La adopción de los percentiles de riesgo cardiovascular evita la sobreestimación o infraestimación del riesgo cardiovascular calculado con el SCORE / Cardiovascular Risk Percentiles Avoid Overestimation or Underestimation of Risk Calculated by the SCORE Risk Function  

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Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Fundamento: La evaluación del riesgo cardiovascular es de máxima importancia para un correcto tratamiento de pacientes con riesgo. Hay varias ecuaciones de riesgo que pueden ser adaptadas a una población para evitar la sobre o infraestimación del riesgo. Se proponen a los percentiles de riesgo como [...] un nuevo método para adaptar los sistemas de valoración del riesgo a nuestra población. Métodos: Se ha realizado un estudio transversal de factores de riesgo cardiovascular en Palencia (ERVPA: Estudio de Riesgo Vascular en PAlencia). Se han registrado las variables edad, sexo, tabaquismo, tensión arterial, diabetes y colesterolemia. Se han estudiado 514 sujetos entre 20 y 79 años procedentes de 9 centros de salud del área sanitaria. Se ha calculado el riesgo cardiovascular fatal según las ecuaciones del proyecto SCORE. Se han calculado y comparado los percentiles obtenidos con cada ecuación, mediante el cálculo de los coeficientes de Spearman y kappa. Resultados: Los porcentajes de sujetos con riesgo alto varían entre el 0% en jóvenes hasta el 92% en los varones y el 67% en las mujeres mayores de 70 años. El coeficiente kappa entre las ecuaciones para países de bajo y alto riesgo es de 0.741. Dicha concordancia varía de forma importante según el sexo y la edad. La concordancia entre los percentiles es casi total. Conclusiones: Los percentiles de riesgo es un método de evaluación del riesgo que permite adaptar cualquier ecuación a una población particular evitando la sobre o infraestimación del riesgo y permiten extrapolar el riesgo a cualquier edad. Abstract in english Background: Cardiovascular risk evaluation is of the utmost importance for treatment of patients with cardiovascular risk factors. There are various scales or equations and they can be adapted to a particular population to try to avoid over or under estimation of risk. We propose risk percentiles as [...] a new method of adapting risk scoring systems to our population. Methods: A cross sectional study of the prevalence of cardiovascular risk factors in the province of Palencia (ERVPA: Cardiovascular Risk Study in Palencia) was conducted. Age, gender, blood pressure, total cholesterol, tobacco consumption and diabetes were evaluated. 514 subjects aged 20 - 79 taken from the general population were studied in 9 health centers from Palencia (Spain). Fatal cardiovascular risk was measured with SCORE project equations. Percentiles were calculated and compared to both equations and a Spearman´s correlation coefficient and a kappa agreement coefficient were calculated. Results: The percentages of high risk range from 0% in young subjects to 92% in males over the age of 70 and 67% in females over the age of 70. The concordance with high risk country equations has a kappa coefficient of 0.741. Concordance varies greatly with age and gender. On comparing the percentiles, the concordance between both equations is almost absolute. Conclusions: Adopting risk percentiles as a method of cardiovascular risk evaluation permits us to adapt any risk equation to a particular area and avoids underestimation or overestimation of risk. Risk percentiles allow us to extrapolate absolute risk for any age.

Jose I, Cuende; Alfredo, Acebal; Azucena, Carrera-Camarón; Florentino, Salado-Cuadrado; Francisco, Díez-Cordero; Ismael, Blanco-Urzáiz; María, Redondo-Valdeolmillos; Nélida, García-Vallejo.

206

La adopción de los percentiles de riesgo cardiovascular evita la sobreestimación o infraestimación del riesgo cardiovascular calculado con el SCORE / Cardiovascular Risk Percentiles Avoid Overestimation or Underestimation of Risk Calculated by the SCORE Risk Function  

Scientific Electronic Library Online (English)

Full Text Available SciELO Public Health | Language: Spanish Abstract in spanish Fundamento: La evaluación del riesgo cardiovascular es de máxima importancia para un correcto tratamiento de pacientes con riesgo. Hay varias ecuaciones de riesgo que pueden ser adaptadas a una población para evitar la sobre o infraestimación del riesgo. Se proponen a los percentiles de riesgo como [...] un nuevo método para adaptar los sistemas de valoración del riesgo a nuestra población. Métodos: Se ha realizado un estudio transversal de factores de riesgo cardiovascular en Palencia (ERVPA: Estudio de Riesgo Vascular en PAlencia). Se han registrado las variables edad, sexo, tabaquismo, tensión arterial, diabetes y colesterolemia. Se han estudiado 514 sujetos entre 20 y 79 años procedentes de 9 centros de salud del área sanitaria. Se ha calculado el riesgo cardiovascular fatal según las ecuaciones del proyecto SCORE. Se han calculado y comparado los percentiles obtenidos con cada ecuación, mediante el cálculo de los coeficientes de Spearman y kappa. Resultados: Los porcentajes de sujetos con riesgo alto varían entre el 0% en jóvenes hasta el 92% en los varones y el 67% en las mujeres mayores de 70 años. El coeficiente kappa entre las ecuaciones para países de bajo y alto riesgo es de 0.741. Dicha concordancia varía de forma importante según el sexo y la edad. La concordancia entre los percentiles es casi total. Conclusiones: Los percentiles de riesgo es un método de evaluación del riesgo que permite adaptar cualquier ecuación a una población particular evitando la sobre o infraestimación del riesgo y permiten extrapolar el riesgo a cualquier edad. Abstract in english Background: Cardiovascular risk evaluation is of the utmost importance for treatment of patients with cardiovascular risk factors. There are various scales or equations and they can be adapted to a particular population to try to avoid over or under estimation of risk. We propose risk percentiles as [...] a new method of adapting risk scoring systems to our population. Methods: A cross sectional study of the prevalence of cardiovascular risk factors in the province of Palencia (ERVPA: Cardiovascular Risk Study in Palencia) was conducted. Age, gender, blood pressure, total cholesterol, tobacco consumption and diabetes were evaluated. 514 subjects aged 20 - 79 taken from the general population were studied in 9 health centers from Palencia (Spain). Fatal cardiovascular risk was measured with SCORE project equations. Percentiles were calculated and compared to both equations and a Spearman´s correlation coefficient and a kappa agreement coefficient were calculated. Results: The percentages of high risk range from 0% in young subjects to 92% in males over the age of 70 and 67% in females over the age of 70. The concordance with high risk country equations has a kappa coefficient of 0.741. Concordance varies greatly with age and gender. On comparing the percentiles, the concordance between both equations is almost absolute. Conclusions: Adopting risk percentiles as a method of cardiovascular risk evaluation permits us to adapt any risk equation to a particular area and avoids underestimation or overestimation of risk. Risk percentiles allow us to extrapolate absolute risk for any age.

Jose I, Cuende; Alfredo, Acebal; Azucena, Carrera-Camarón; Florentino, Salado-Cuadrado; Francisco, Díez-Cordero; Ismael, Blanco-Urzáiz; María, Redondo-Valdeolmillos; Nélida, García-Vallejo.

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Left ventricular end-diastolic pressure and risk of subsequent heart failure in patients following an acute myocardial infarction.  

Science.gov (United States)

Left ventricular end-diastolic pressure (LVEDP) is an important measure of ventricular performance and may identify patients at increased risk for developing late clinical symptoms of heart failure (HF). The primary outcome in this analysis of 744 patients from the Survival and Ventricular Enlargement (SAVE) trial was the development of death or HF over a mean time of 36 months. The mean LVEDP for all patients was 23+/-9 mm Hg, and 75% of participants (n=558) had an LVEDP >15 mm Hg. Patients with an LVEDP >30 mm Hg (n=187) had the highest risk of death or HF (unadjusted hazard ratio, 1.40; 95% confidence interval [CI], 1.00-1.97) when compared with the other 2 cohorts combined (n=603). After adjustment for other known predictors of cardiac risk, LVEDP no longer remained significant (adjusted hazard ratio, 1.12; 95% CI, 0.77-1.65). Elevated LVEDP is common following myocardial infarction; however, it is not an independent predictor of subsequent HF risk. The variability in LVEDP is not fully explained by infarct size and atherosclerotic burden. PMID:17673873

Mielniczuk, Lisa M; Lamas, Gervasio A; Flaker, Greg C; Mitchell, Gary; Smith, Sidney C; Gersh, Bernard J; Solomon, Scott D; Moyé, Lemuel A; Rouleau, Jean L; Rutherford, John D; Pfeffer, Marc A

2007-01-01

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Primeiro escore de risco inflamatório das endopróteses de aorta / First inflammatory risk score for aortic endoprostheses  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Propor um escore de risco inflamatório para tratamento endovascular dos aneurismas da aorta. MÉTODOS: Vinte e cinco pacientes foram seguidos do período pré-operatório até 3º mês de pós-operatório (1 hora, 6 horas, 24 horas, 48 horas, 7 dias, 1 mês, 2 meses e 3 meses). Variáveis inflamatóri [...] as avaliadas foram proteína C reativa, velocidade de hemossedimentação, interleucinas (IL-6, IL8), fator de necrose tumoral alfa, L-selectina, molécula de adesão intercelular (ICAM-1), transfusão de hemáceas, volume de cristalóide, volume de contraste, material da prótese, número de próteses, contagem total de leucócitos e linfócitos. O teste de Spearman apontou as variáveis candidatas ao maior risco inflamatório, segundo P Abstract in english OBJECTIVE: To purpose an inflammatory risk score for aortic aneurysm endovascular treatment. METHODS: Twenty-five patients were followed-up from preoperative period to third month postoperatively (1-hour, 6-hour, 24-hour, 48-hour, 7-day, 1-month, 2- month and 3month). Inflammatory variables were C-r [...] eactive protein, hemosedimentation velocity, interleukins (IL-6, IL-8), tumor necrosis factor-Alpha, L-selectin, intercellular adhesion molecule (ICAM-1), red blood cells transfusion, volume of crystalloid, volume of contrast, type of endoprosthesis, number of endoprostheses, total count of leukocytes and lymphocytes. Spearman test defined the variables considered as candidates to higher inflammatory risk based on P

Gabriel, Edmo Atique; Locali, Rafael Fagionato; Matsoka, Priscila Katsumi; Romano, Carla Cristina; Duarte, Alberto José da Silva; Buffolo, Enio.

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

DEFF Research Database (Denmark)

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.

Kasch, Helge; Qerama, Erisela

2011-01-01

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Risk factors and myocardial infarction in patients with obstructive sleep apnea: impact of ?2-adrenergic receptor polymorphisms  

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Full Text Available Abstract Background The increased sympathetic nervous activity in patients with obstructive sleep apnea (OSA is largely responsible for the high prevalence of arterial hypertension, and it is suggested to adversely affect triglyceride and high-density lipoprotein (HDL cholesterol levels in these patients. The functionally relevant polymorphisms of the ?2-adrenergic receptor (Arg-47Cys/Arg16Gly and Gln27Glu have been shown to exert modifying effects on these risk factors in previous studies, but results are inconsistent. Methods We investigated a group of 429 patients (55 ± 10.7 years; 361 men, 68 women with moderate to severe obstructive sleep apnea (apnea/hypopnea index (AHI 29.1 ± 23.1/h and, on average, a high cardiovascular risk profile (body mass index 31.1 ± 5.6, with hypertension in 60.1%, dyslipidemia in 49.2%, and diabetes in 17.2% of patients. We typed the ?2-adrenergic receptor polymorphisms and investigated the five most frequent haplotypes for their modifying effects on OSA-induced changes in blood pressure, heart rate, and lipid levels. The prevalence of cardiovascular risk factors and coronary heart disease (n = 55, 12.8% and survived myocardial infarction (n = 27, 6.3% were compared between the genotypes and haplotypes. Results Multivariate linear/logistic regressions revealed a significant and independent (from BMI, age, sex, presence of diabetes, use of antidiabetic, lipid-lowering, and antihypertensive medication influence of AHI on daytime systolic and diastolic blood pressure, heart rate, prevalence of hypertension, and triglyceride and HDL levels. The ?2-adrenergic receptor genotypes and haplotypes showed no modifying effects on these relationships or on the prevalence of dyslipidemia, diabetes, and coronary heart disease, yet, for all three polymorphisms, heterozygous carriers had a significantly lower relative risk for myocardial infarction (Arg-47Cys: n = 195, odds ratio (OR = 0.32, P = 0.012; Arg16Gly: n = 197, OR = 0.39, P = 0.031; Gln27Glu: OR = 0.37, P = 0.023. Carriers of the most frequent haplotype (n = 113 (haplotype 1; heterozygous for all three polymorphisms showed a five-fold lower prevalence of survived myocardial infarction (OR = 0.21, P = 0.023. Conclusion Our study showed no significant modifying effect of the functionally relevant ?2-adrenergic receptor polymorphisms on OSA-induced blood pressure, heart rate, or lipid changes. Nevertheless, heterozygosity of these polymorphisms is associated with a lower prevalence of survived myocardial infarction in this group with, on average, a high cardiovascular risk profile.

Mügge Andreas

2007-01-01

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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)

Full Text Available SciELO Mexico | Language: Spanish Abstract in spanish 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.

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

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

LENUS (Irish Health Repository)

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.

Haines, David E

2012-02-01

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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.  

Science.gov (United States)

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. PMID:24584550

Lønborg, Jacob; Vejlstrup, Niels; Kelbæk, Henning; Nepper-Christensen, Lars; Jørgensen, Erik; Helqvist, Steffen; Holmvang, Lene; Saunamäki, Kari; Bøtker, Hans Erik; Kim, Won Yong; Clemmensen, Peter; Treiman, Marek; Engstrøm, Thomas

2014-07-01

214

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)

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.

Nepper-Christensen, Lars; Holmvang, Lene

2014-01-01

215

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

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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.

Graziela Araujo Costa

2010-01-01

216

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

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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...

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

1990-01-01

217

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)

Full Text Available SciELO Colombia | Language: Spanish Abstract in spanish 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 tha

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

218

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

Science.gov (United States)

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....

219

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

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Full Text Available 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 lower than in control women (3214 vs. 3370 gram, mean difference -156.3 gram (95%CI -9.5 to -303.1. The odds ratio for myocardial infarction, associated with a birth weight lower than 3000 gram (20th percentile in controls compared to higher than 3000 gram was 1.7 (95%CI 1.1–2.7, while the odds ratio for myocardial infarction for children with a low birth weight ( Conclusions Low birth weight is associated with an increased risk of myocardial infarction before age of 50 in Dutch women.

Rosendaal Frits R

2005-01-01

220

[Importance of late reversibility in the identification of myocardial viability at risk after myocardial infarction].  

Science.gov (United States)

The prevalence of late reversibility in single photon emission computed tomography (SPECT) thallium 201 stress/redistribution studies is still controversial. The aim of our work was to evaluate the prevalence of late reversibility at infarct site in an unselected population of patients with previous acute myocardial infarction (AMI). We studied by SPECT thallium 201 and pharmacologic stress with dipyridamole (DIP) as well as by two-dimensional echocardiography 58 consecutive patients with previous AMI (50 men of mean age 57 years, range 40-73; 8 women of mean age 58 years, range 50-68). All the patients with perfusion defect at infarct site that was persistent at 4-hour study, were reimaged after 24 hours. Twenty-one (36%) of 58 patients complained about postinfarction angina. Following intravenous DIP (0.56 mg/kg), heart rate increased from 67 +/- 14 to 83 +/- 14 b/min (< 0.0001) and diastolic and systolic arterial pressures dropped from 86 +/- 12 and 139 +/- 25 mmHg to 79 +/- 14 and 132 +/- 27 mmHg, respectively (< 0.0001; < 0.0005). Of 57 patients with stress perfusion defects at infarct site, 16 (28%) demonstrated reversibility after 4 hours and 19 (33.4%) after 24 hours, with a total of 35 (61.4%) patients demonstrating reversibility by combined 4-hour and 24-hour imaging (< 0.0001 versus reversibility at 4-hour imaging alone). Thus, of 41 patients with 4-hour persistent thallium defects at infarct site, 19 (46.3%) demonstrated late reversibility.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1423366

Palagi, B; Baroffio, R; Picozzi, R; Zoccarato, O

1992-05-01

 
 
 
 
221

High-risk subgroup of inferior myocardial infarction. Importance of anterior wall motion and right ventricular function  

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To identify high-risk subgroups of inferior myocardial infarction, 75 patients presenting with their first inferior infarction were investigated by sequential gated blood pool scans. The patients were divided into four groups based on the right ventricular function (RVF) and anterior wall motion (AWM) of the left ventricle by scan at the time of admission. A second blood pool scan was performed at ten days to evaluate RV and LV function. Thirty-eight patients had cardiac catheterization before discharge and all patients were followed up for one year to determine their clinical outcome. Depressed RVF and reduced AWM were observed in 26 (35%) (Group A); depressed RVF and normal AWM were found in 20 (27%) (Group B); reduced AWM and normal RVE in 10 (13%) (Group C); and normal RVF and AWM in 19 (25%) (Group D). The mean values of biventricular function (LVEF, RVEF) in groups A, B, C, and D were (44.9 +- 8.4%, 32.5 +- 9.9%), (59.9 +- 8.6%, 34.5 +- 8.0%), (44.9 +- 15.7%, 48.2 +- 3.3%), and (60.4 +- 9.1%, 51.6 +- 10.6%), respectively, at admission. In serial measurements, LVEF did not change significantly in any group, however, RVEF improved nearly 10 points in groups A and B at 10 days. Group A also had the highest incidence (82 %) of left anterior descending coronary artery involvement, and the highest mean creatine phosphokinase levels (762 +- 318 U/1): Furthermore, group A had a high incidence of major complications during their hospital course and high mortality during the one-year follow-up. These data clearly identified group A as a high-risk subgroup of patients with inferior infarction.

Nishimura, Tsunehiko; Yasuda, Tsunehiro; Gold, H.K.; Leinbach, R.C.; Boucher, C.A.; McKusick, K.A.; Strauss, H.W.

1986-12-01

222

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

DEFF Research Database (Denmark)

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.

Svendsen, Jesper Hastrup; Nielsen, Jens Cosedis

2013-01-01

223

Development of a risk score for low back pain in office workers - a cross-sectional study  

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Abstract Background Low back pain (LBP) is common among office workers and is the most common cause of work-related disability in people under 45 years of age. The aetiology of LBP is widely accepted to be multi-factorial. Prognostic research into office workers at risk of developing LBP has received limited attention. The aims of this study were to develop a risk score to identify office workers likely to have LBP and to evaluate its predictive power. Methods 3...

2011-01-01

224

A practice-related risk score (PRS): a DOPPS-derived aggregate quality index for haemodialysis facilities  

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Background. The Dialysis Outcomes and Practice Patterns Study (DOPPS) database was used to develop and validate a practice-related risk score (PRS) based on modifiable practices to help facilities assess potential areas for improving patient care. Methods. Relative risks (RRs) from a multivariable Cox mortality model, based on observational haemodialysis (HD) patient data from DOPPS I (1996-2001, seven countries), were used. The four practices were the percent of patients with Kt/V >= 1.2...

Mendelssohn, David C.; Pisoni, Ronald L.; Arrington, Charlotte J.; Yeates, Karen E.; Leblanc, Martine; Deziel, Clement; Akiba, Takashi; Krishnan, Mahesh; Fukuhara, Shunichi; Lameire, Norbert; Port, Friedrich K.; Wolfe, Robert A.

2008-01-01

225

Development of a risk score for low back pain in office workers - a cross-sectional study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Low back pain (LBP is common among office workers and is the most common cause of work-related disability in people under 45 years of age. The aetiology of LBP is widely accepted to be multi-factorial. Prognostic research into office workers at risk of developing LBP has received limited attention. The aims of this study were to develop a risk score to identify office workers likely to have LBP and to evaluate its predictive power. Methods 397 office workers filled out a self-administered questionnaire and underwent physical examination. The questionnaire gathered data on individual, work-related physical and psychosocial data as well as the presence of low back pain in the previous 4 weeks. The physical examination included measurement of body weight, height, waist circumference, hamstrings length, spinal scoliosis, spinal curve, Backache Index and lumbar stability. Logistic regression was used to select significant factors associated with LBP to build a risk score. The coefficients from the logistic regression model were transformed into the components of a risk score. Results The model included six items: previous history of working as an office worker, years of work experience, continuous standing for >2 hrs/d, frequency of forward bending during work day, chair having lumbar support and Backache Index outcome. The risk score for LBP in office workers (The Back pain Risk score for Office Workers: The BROW was built with a risk score ranging from 0 to 9. A cut-off score of ?4 had a sensitivity of 80% and a specificity of 58%. The positive predictive value and negative predictive values were 70% each. Conclusions The BROW is easy and quick to administer. It appears to have reasonable sensitivity, specificity, positive predictive value and negative predictive values for the cut-off point of ?4. The BROW is a promising tool for use to identify office workers in need of early interventions. Further prospective study is needed to validate the predictive performance of the BROW.

Moolkay Patriya

2011-01-01

226

The Association of Tobacco Control Policies and the Risk of Acute Myocardial Infarction Using Hospital Admissions Data  

Science.gov (United States)

Objective To evaluate the association of a nationwide comprehensive smoking ban (CSB) and tobacco tax increase (TTI) on the risk of acute myocardial infarctions (AMI) in Panama for the period of 2006 – 2010 using hospital admissions data. Methods Data of AMI cases was gathered from public and private hospitals in the country for the period of January 1, 2006 to December 31, 2010. The number of AMI cases was calculated on a monthly basis. The risk of AMI was estimated for the pre-CSB period (January 2006 to April 2008) and was used as a reference point. Three post-intervention periods were examined: (1) post-CSB from May 2008 to April 2009 (12 months); (2) post-CSB from May 2009 to November 2009 (7 months); and (3) post-TTI from December 2009 to December 2010 (13 months). Relative risks (RR) of AMI were estimated for each post intervention periods by using a Poisson regression model. Mortality registries for the country attributed to myocardial infarction (MI) were obtained from January 2001 to December 2012. The annual percentage change (APC) of the number of deaths from MI was calculated using Joinpoint regression analysis. Results A total sample size of 2191 AMI cases was selected (monthly mean number of cases 36.52±8.24 SD). Using the pre-CSB as a reference point (RR?=?1.00), the relative risk of AMI during the first CSB period, the second CSB period and post-TTI were 0.982, 1.049, and 0.985, respectively. The APC of deaths from MI from January 2001 to April 2008 was 0.5%. From January 2001 to June 2010 the APC trend was 0.47% and from July 2010 to December 2012 the APC was –0.3%. Conclusions The implementation of a CSB and TTI in Panama were associated with a decrease in tobacco consumption and a reduction of the RR of AMI.

Jan, Carmen; Lee, Marcos; Roa, Reina; Herrera, Victor; Politis, Michael; Motta, Jorge

2014-01-01

227

The survival outcomes following liver transplantation (SOFT) score: validation with contemporaneous data and stratification of high-risk cohorts.  

Science.gov (United States)

Models to project survival after liver transplantation are important to optimize outcomes. We introduced the survival outcomes following liver transplantation (SOFT) score in 2008 (1) and designed to predict survival in liver recipients at three months post-transplant with a C statistic of 0.70. Our objective was to validate the SOFT score, with more contemporaneous data from the OPTN database. We also applied the SOFT score to cohorts of the sickest transplant candidates and the poorest-quality allografts. Analysis included 21 949 patients transplanted from August 1, 2006, to October 1, 2010. Kaplan-Meier survival functions were used for time-to-event analysis. Model discrimination was assessed using the area under the receiver operating characteristic (ROC) curve. We validated the SOFT score in this cohort of 21 949 liver recipients. The C statistic was 0.70 (CI 0.68-0.71), identical to the original analysis. When applied to cohorts of high-risk recipients and poor-quality donor allografts, the SOFT score projected survival with a C statistic between 0.65 and 0.74. In this study, a validated SOFT score was informative among cohorts of the sickest transplant candidates and the poorest-quality allografts. PMID:23808891

Rana, Abbas; Jie, Tun; Porubsky, Marian; Habib, Shahid; Rilo, Horacio; Kaplan, Bruce; Gruessner, Angelika; Gruessner, Rainer

2013-01-01

228

Is there a role for coronary artery calcium scoring for management of asymptomatic patients at risk for coronary artery disease?: Clinical risk scores are not sufficient to define primary prevention treatment strategies among asymptomatic patients.  

Science.gov (United States)

Although risk factors have proven to be useful therapeutic targets, they are poor predictors of risk. Traditional risk scores are moderately successful in predicting future CHD events and can be a starting place for general risk categorization. However, there is substantial heterogeneity between traditional risk and actual atherosclerosis burden, with event rates predominantly driven by burden of atherosclerosis. Serum biomarkers have yet to show any clinically significant incremental value to the FRS and even when combined cannot match the predictive value of atherosclerosis imaging. As clinicians, are we willing to base therapy decisions on risk models that lack optimum-achievable accuracy and limit personalization? The decision to treat a patient in primary prevention must be a careful one because the benefit of therapy in an asymptomatic patient must clearly outweigh the potential risk. CAC, in particular, provides a personalized assessment of risk and may identify patients who will be expected to derive the most, and the least, net absolute benefit from treatment. Emerging evidence hints that CAC may also promote long-term adherence to aspirin, exercise, diet, and statin therapy. When potentially lifelong treatment decisions are on the line, clinicians must arm their patients with the most accurate risk prediction tools, and subclinical atherosclerosis testing with CAC is, at the present time, superior to any combination of risk factors and serum biomarkers. PMID:24642922

Blaha, Michael J; Silverman, Michael G; Budoff, Matthew J

2014-03-01

229

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

DEFF Research Database (Denmark)

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 run of >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.

Sajadieh, A; Nielsen, OW

2006-01-01

230

Anemia is an independent risk for mortality after acute myocardial infarction in patients with and without diabetes  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Anemia and diabetes are risk factors for short-term mortality following an acute myocardial infarction(AMI. Anemia is more prevalent in patients with diabetes. We performed a retrospective study to assess the impact of the combination of diabetes and anemia on post-myocardial infarction outcomes. Methods Data relating to all consecutive patients hospitalized with AMI was obtained from a population-based disease-specific registry. Patients were divided into 4 groups: diabetes and anemia (group A, n = 716, diabetes and no anemia (group B, n = 1894, no diabetes and anemia (group C, n = 869, and no diabetes and no anemia (group D, n = 3987. Mortality at 30 days and 31 days to 36 months were the main outcome measures. Results 30-day mortality was 32.3% in group A, 16.1% in group B, 21.5% in group C, 6.6% in group D (all p Interpretation Patients with both diabetes and anemia have a significantly higher mortality than those with either diabetes or anemia alone. Cardiovascular death remained the most likely cause of mortality in all groups.

Kaiser Stephanie M

2006-04-01

231

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  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese 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 ( Abstract in english 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 pati [...] ents 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

Ayrton R., Massaro; Ralph L., Sacco; Milberto, Scaff; J.P., Mohr.

232

Comparing the probability of stroke by the Framingham risk score in hypertensive Korean patients visiting private clinics and tertiary hospitals  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The purpose of this study was to investigate the pattern of distribution of risk factors for stroke and the 10-year probability of stroke by the Framingham risk score in hypertensive patients visiting private clinics vs. tertiary hospitals. Methods A total of 2,490 hypertensive patients who attended 61 private clinics (1088 patients and 37 tertiary hospitals (1402 patients were enrolled. The risk factors for stroke were evaluated using a series of laboratory tests and physical examinations, and the 10-year probability of stroke was determined by applying the Framingham stroke risk equation. Results The proportion of patients who had uncontrolled hypertension despite the use of antihypertensive agents was 49% (66 and 36% of patients cared for at private clinics and tertiary hospitals, respectively; p Conclusions Since the 10-year probability of stroke by the Framingham risk score in hypertensive patients attending tertiary hospitals was higher than the risk for patients attending private clinics. We suggest that the more aggressive interventions are needed to prevent and early detect an attack of stroke in hypertensive patients attending tertiary hospitals.

Choi Cheol

2010-09-01

233

Validation of the European Group for Blood and Marrow Transplantation (EBMT) risk score in patients receiving allogeneic hematopoietic stem cell transplantation at a single center in Japan.  

Science.gov (United States)

We validated the European Group for Blood and Marrow Transplantation (EBMT) risk score in 273 consecutive adult patients receiving allogeneic hematopoietic stem cell transplantation between 2000 and 2010 at our center. The patients were divided into four groups according to the EBMT risk score: low risk (LR, score 0-2), intermediate risk-1 (IR-1, score 3), intermediate risk-2 (IR-2, score 4), and high risk (HR, score 5-7). The five-yr overall survival of the LR (n = 65), IR-1 (n = 67), IR-2 (n = 70), and HR (n = 71) groups was 72%, 57%, 41%, and 25%, respectively (p < 0.001). The five-yr transplant-related mortality rates were 16%, 30%, 25%, and 36%, respectively (p = 0.07). The five-yr cumulative incidence of relapse was 20%, 18%, 37%, and 41%, respectively (p < 0.001). In the subgroup analysis, the prognostic value of the EBMT risk score was confirmed in patients undergoing myeloablative conditioning (MAC), but not in those undergoing reduced-intensity conditioning (RIC). The results suggest that the EBMT risk score is a useful tool to predict transplant outcome for patients undergoing MAC, but not for those undergoing RIC and may be beneficial for stratifying patients in clinical studies. PMID:24655161

Numata, Ayumi; Tanaka, Masatsugu; Matsumoto, Kenji; Takasaki, Hirotaka; Tachibana, Takayoshi; Fujimaki, Katsumichi; Sakai, Rika; Fujisawa, Shin; Tomita, Naoto; Fujita, Hiroyuki; Maruta, Atsuo; Ishigatsubo, Yoshiaki; Kanamori, Heiwa

2014-04-01

234

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

DEFF Research Database (Denmark)

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.

Olesen, Kasper; Rugulies, Reiner

2014-01-01

235

Extreme lipoprotein(a) levels and risk of myocardial infarction in the general population: the Copenhagen City Heart Study  

DEFF Research Database (Denmark)

BACKGROUND: Elevated lipoprotein(a) levels are associated with myocardial infarction (MI) in some but not all studies. Limitations of previous studies include lack of risk estimates for extreme lipoprotein(a) levels, measurements in long-term frozen samples, no correction for regression dilution bias, and lack of absolute risk estimates in the general population. We tested the hypothesis that extreme lipoprotein(a) levels predict MI in the general population, measuring levels shortly after sampling, correcting for regression dilution bias, and calculating hazard ratios and absolute risk estimates. METHODS AND RESULTS: We examined 9330 men and women from the general population in the Copenhagen City Heart Study. During 10 years of follow-up, 498 participants developed MI. In women, multifactorially adjusted hazard ratios for MI for elevated lipoprotein(a) levels were 1.1 (95% CI, 0.6 to 1.9) for 5 to 29 mg/dL (22nd to 66th percentile), 1.7 (1.0 to 3.1) for 30 to 84 mg/dL (67th to 89th percentile), 2.6 (1.2 to 5.9) for 85 to 119 mg/dL (90th to 95th percentile), and 3.6 (1.7 to 7.7) for > or =120 mg/dL (>95th percentile) versus levels 60 years with lipoprotein(a) levels of or =120 mg/dL, respectively. Equivalent values in men were 19% and 35%. CONCLUSIONS: We observed a stepwise increase in risk of MI with increasing levels of lipoprotein(a), with no evidence of a threshold effect. Extreme lipoprotein(a) levels predict a 3- to 4-fold increase in risk of MI in the general population and absolute 10-year risks of 20% and 35% in high-risk women and men Udgivelsesdato: 2008/1/15

Kamstrup, P.R.; Benn, M.

2008-01-01

236

Coronary artery calcium score. Influence of the reconstruction interval on cardiac risk stratification in asymptomatic patients using dual-source computed tomography  

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To evaluate the impact of the reconstruction interval on coronary calcium score and cardiac risk stratification using dual-source computed tomography (DSCT). Materials and Methods: DSCT coronary calcium scoring was performed in 61 consecutive patients, and five data sets per patient were reconstructed within diastole (50 - 70 % of the R-R interval). The Agatston score, volumetric score and the relative variability were assessed for all reconstructions. To assess the individual cardiovascular risk, patients were assigned to risk groups based on age and gender-matched percentile ranks. Results: The mean Agatston score was 184.8{+-}377.9 (relative variability 47%{+-}52%). The mean volumetric score was 164.4{+-}310.1 (relative variability 49%{+-}58%). There was a negative correlation between the total Agatston score and the relative variability (r = -0.37; p < 0.01). Depending on the reconstruction interval used, 18 predominantly young patients were assigned to more than one risk group. Conclusion: Despite the increased temporal resolution of DSCT examinations, the Agatston and volumetric scores depend on the reconstruction time within the cardiac cycle. The fact that the greatest relative variability for both the Agatston score and the volumetric score was found in young patients with small amounts of coronary calcium may result in different treatment strategies for young patients depending on the reconstruction used. Therefore, more accurate risk stratification may require the analysis of multiple reconstruction intervals. (orig.)

Jensen, Christoph J.; Jochims, M.; Eberle, H.C.; Wolf, A.; Bruder, O. [Elisabeth Krankenhaus Essen (Germany). Klinik fuer Kardiologie und Angiologie; Nassenstein, K.; Forsting, M.; Schlosser, T. [Universitaetsklinikum Essen (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie und Neuroradiologie

2011-03-15

237

A simple risk tool (the OBSERVANT score) for prediction of 30-day mortality after transcatheter aortic valve replacement.  

Science.gov (United States)

Risk stratification tools used in patients with severe aortic stenosis have been mostly derived from surgical series. Although specific predictors of early mortality with transcatheter aortic valve replacement (TAVR) have been identified, the prognostic impact of their combination is unexplored. We sought to develop a simple score, using preprocedural variables, for prediction of 30-day mortality after TAVR. A total of 1,878 patients from a national multicenter registry who underwent TAVR were randomly assigned in a 2:1 manner to development and validation data sets. Baseline characteristics of the 1,256 patients in the development data set were considered as candidate univariate predictors of 30-day mortality. A bootstrap multivariate logistic regression process was used to select correlates of 30-day mortality that were subsequently weighted and integrated into a scoring system. Seven variables were weighted proportionally to their respective odds ratios for 30-day mortality (glomerular filtration rate balloon aortic valvuloplasty [3 points], and left ventricular ejection fraction <40% [3 points]). The model showed good discrimination in both the development and validation data sets (C statistics 0.73 and 0.71, respectively). Compared with the logistic European System for Cardiac Operative Risk Evaluation in the validation data set, the model showed better discrimination (C statistic 0.71 vs 0.66), goodness of fit (Hosmer-Lemeshow p value 0.81 vs 0.00), and global accuracy (Brier score 0.054 vs 0.073). In conclusion, the risk of 30-day mortality after TAVR may be estimated by combining 7 baseline clinical variables into a simple risk scoring system. PMID:24837264

Capodanno, Davide; Barbanti, Marco; Tamburino, Corrado; D'Errigo, Paola; Ranucci, Marco; Santoro, Gennaro; Santini, Francesco; Onorati, Francesco; Grossi, Claudio; Covello, Remo Daniel; Capranzano, Piera; Rosato, Stefano; Seccareccia, Fulvia

2014-06-01

238

Simple Integer Risk Score to Determine Prognosis of Patients With Hypertension and Chronic Stable Coronary Artery Disease  

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Background: It is difficult to accurately determine prognosis of patients with hypertension and chronic stable coronary artery disease (CAD). Our aim was to construct a risk score for predicting important adverse events in this population. Methods and Results: Patients with hypertension and chronic stable CAD enrolled in the INternational VErapamil?SR/Trandolapril STudy (INVEST) comprised the study cohort. Candidate predictor variables were obtained from patients with at least 1 postbaselin...

Bavry, Anthony A.; Kumbhani, Dharam J.; Gong, Yan; Handberg, Eileen M.; Cooper?dehoff, Rhonda M.; Pepine, Carl J.

2013-01-01

239

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

Energy Technology Data Exchange (ETDEWEB)

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.

Morris, S.C.; Meinhold, A.F.

1995-05-01

240

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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 pur [...] pose 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

Graziela Araujo, Costa; Arthur F., Delgado; Alexandre, Ferraro; Thelma Suely, Okay.

 
 
 
 
241

Changes over time in risk factors for cardiovascular disease and use of lipid-lowering drugs in HIV-infected individuals and impact on myocardial infarction  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 Eve...

2008-01-01

242

Changes over time in risk factors for cardiovascular disease and use of lipid-lowering drugs in HIV-infected individuals and impact on myocardial infarction  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 Ev...

2008-01-01

243

A risk score model for the metastasis of level Ib lymph node based on the clinicopathological features of nasopharyngeal carcinoma in a large sample  

Science.gov (United States)

The aim of the present study was to develop a metastatic risk score model of neck level Ib lymph nodes in primary nasopharyngeal carcinoma (NPC) to guide the level Ib radiotherapy. There were a total of 1,557 patients enrolled in the study, and of these patients, 1,145 were included in the training set. Univariate ?2 analysis and multivariate logistic regression analyses were used to screen the independent risk factors to construct the risk score model. A total of 85 patients in the validating set underwent a pathology biopsy of level Ib lymph nodes to test the model. The remaining 327 patients from the prognostic-research set were used to evaluate the prognostic impact of level Ib irradiation in high- and low-risk groups. The independent risk factors in the model were carotid sheath involvement, the maximal diameter of the neck lymph nodes (?20 mm) and the involvement of the level II/III/IV lymph nodes. The involvement of level IV was assigned score 2 and the other risk factors were assigned score 1. According to the total scores, the patients were divided into the low- (total score, 0–1; level Ib metastasis rate, 0.5%) and high-risk groups (total score, 2–4; level Ib metastasis rate, 8.5%). In the validating set, the metastatic rate of level Ib in 43 low-risk patients was 0%, and the rate was 31.0% (13/42) in 42 high-risk patients. In the prognostic-research set, the prognosis of 137 low-risk patients was not affected by level Ib irradiation. However, level Ib unirradiation was an independent prognostic factor for the locoregional recurrence in 190 high-risk patients. According to the data, the novel score model could help assess the metastatic risk of level Ib in primary NPC, and the radiotherapy on level Ib may impact the locoregional recurrence in high-risk patients.

YI, WEI; LI, XIAN; LIU, ZHIGANG; JIANG, CHANGBIN; NIU, DAOLI; XIA, YUNFEI

2014-01-01

244

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 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)

2011-06-01

245

Postpartal recurrent non-ST elevation myocardial infarction in essential thrombocythaemia: case report and review of the literature  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Normal pregnancy corresponds to a procoagulant state. Acute myocardial infarction during pregnancy is rare, yet considering the low non-pregnant risk score of childbearing women it is still surprisingly frequent. We report a case of postpartum recurrent non-ST elevation myocardial infarction in a 40-year-old caucasian woman with essential thrombocythaemia in the presence of a positive JAK-2 mutation and an elevated anti-cardiolipin IgM antibody titer. In the majority of cas...

Arampatzis Spyridon; Stefanidis Ioannis; Lakiopoulos Vassilios; Raio Luigi; Surbek Daniel; Mohaupt Markus G

2010-01-01

246

Industry-specific risk models for numerical scoring of hazards and prioritization of safety measures  

International Nuclear Information System (INIS)

Risk analysis consists of five cornerstones that have to be viewed in an holistic manner by risk practitioners of any organization regardless of the industry type or nature of its critical infrastructures. The cornerstones are hazard identification, risk assessment and consequence analysis, determination of risk management actions required to reduce risks to acceptable levels, communication of risk insights among the stake-holders, and continuous monitoring and verification to ensure sustained attainment of tolerable risk levels. Our primary objectives in this research are two fold: first, we compare and contrast a wide spectrum of current industry-specific and application-dependent semi-quantitative risk models. Secondly, based on the insights to be gained from the first task, we propose a framework for a robust risk-based approach for conducting security vulnerability assessment (SVA). Risk practitioners of critical infrastructures, such as commercial nuclear power plants, water utilities, chemical plants, transmission and distribution substations... etc., could readily use this proposed approach to classify, evaluate, and prioritize risks to support allocation of resources required to ensure protection of public health and safety. (author)

2004-04-25

247

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

1986-10-24

248

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

LENUS (Irish Health Repository)

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.

Cooney, Marie Therese

2009-09-29

249

Development and Validation of a Clinical Scoring System for Predicting Risk of HCC in Asymptomatic Individuals Seropositive for Anti-HCV Antibodies  

Science.gov (United States)

Background The development of a risk assessment tool for long-term hepatocellular carcinoma risk would be helpful in identifying high-risk patients and providing information of clinical consultation. Methods The model derivation and validation cohorts consisted of 975 and 572 anti-HCV seropositives, respectively. The model included age, alanine aminotransferase (ALT), the ratio of aspirate aminotransferase to ALT, serum HCV RNA levels and cirrhosis status and HCV genotype. Two risk prediction models were developed: one was for all-anti-HCV seropositives, and the other was for anti-HCV seropositives with detectable HCV RNA. The Cox's proportional hazards models were utilized to estimate regression coefficients of HCC risk predictors to derive risk scores. The cumulative HCC risks in the validation cohort were estimated by Kaplan-Meier methods. The area under receiver operating curve (AUROC) was used to evaluate the performance of the risk models. Results All predictors were significantly associated with HCC. The summary risk scores of two models derived from the derivation cohort had predictability of HCC risk in the validation cohort. The summary risk score of the two risk prediction models clearly divided the validation cohort into three groups (p<0.001). The AUROC for predicting 5-year HCC risk in the validation cohort was satisfactory for the two models, with 0.73 and 0.70, respectively. Conclusion Scoring systems for predicting HCC risk of HCV-infected patients had good validity and discrimination capability, which may triage patients for alternative management strategies.

Lee, Mei-Hsuan; Lu, Sheng-Nan; Yuan, Yong; Yang, Hwai-I; Jen, Chin-Lan; You, San-Lin; Wang, Li-Yu; L'Italien, Gilbert; Chen, Chien-Jen

2014-01-01

250

Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Sexually transmitted infections constitute the main health risk among adolescents. In developing countries the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among female adolescents from a Health Sector of the city of Goiânia, Brazil, and validated cervicitis diagnosis using World Health Organization/Ministry of Health risk score and gynecological examination. Methods A cross-sectional community-based sample of 914 15- to 19-year-old female teenagers was randomly selected and referred to the local Family Health Program. Of these, 472 (51.6% were sexually active and gynecological examinations were carried out for 427. Endocervical samples were collected to perform the polymerase chain reaction for C. trachomatis and N. gonorrhoeae. Performance of risk score, the presence of mucopurulent discharge, friability, ectopia and pain during cervical maneuver were compared with the presence of C. trachomatis or N. gonorrhoeae or both. Results The prevalence of C. trachomatis and N. gonorrhoeae was 14.5% and 2.1%, respectively. The risk score had a specificity of 31.9% (95% confidence interval, 21.2 to 44.2 and a positive predictive value of 20.8% (95% confidence interval, 13.5 to 29.7. Friability was the component of the gynecological examination that presented the best performance with a sensitivity of 43.5%, specificity of 81.0%, and 30.6% of positive predictive value. Conclusion The prevalence of infection by C. trachomatis and N. gonorrhoeae was high among these sexually active adolescents. The syndromic approach is clearly inadequate for screening and treating these infections in this population. Therefore, the implantation of other strategies to control these infections among adolescents is urgently required.

Côrtes Rejane LM

2009-03-01

251

First myocardial infarction in patients of Indian subcontinent and European origin: comparison of risk factors, management, and long term outcome.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

OBJECTIVE: To compare long term outcome after first myocardial infarction among British patients originating from the Indian subcontinent and from Europe. DESIGN: Matched pairs study. SETTING: Coronary care unit in central Leicester. SUBJECTS: 238 pairs of patients admitted during 1987-93 matched for age (within 2 years), sex, date of admission (within 3 months), type of infarction (Q/non-Q), and site of infarction. MAIN OUTCOME MEASURES: Incidence of angina, reinfarction, or death during fol...

Shaukat, N.; Lear, J.; Lowy, A.; Fletcher, S.; Bono, D. P.; Woods, K. L.

1997-01-01

252

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

DEFF Research Database (Denmark)

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.

Nielsen, Michael René Skjelbo; Schmidt, Erik Berg

2013-01-01

253

A population-based case-cohort study of the risk of myocardial infarction following radiation therapy for breast cancer  

International Nuclear Information System (INIS)

Objective: To describe the risk of acute myocardial infarction (AMI) after radiation therapy (RT) for breast cancer (BrCa) in an exposed population. Methods: We identified and validated cases of AMI (vAMI), by electrocardiographic or enzyme criteria, among all 6680 women who received post-operative RT following lumpectomy or mastectomy, within 12 months following diagnosis of BrCa between 1982 and 1988 in Ontario, Canada. We identified women without vAMI whose death certification was ascribed to AMI (dAMI). We abstracted risk factors and treatment exposures for a random sample of women from the 6680, and for all with vAMI or dAMI. The hazards of vAMI and of dAMI were estimated using multivariate Cox proportional hazards models, corrected for study design. Results: We validated 121 cases of vAMI and identified 92 cases of dAMI. The risk of vAMI associated with RT to the left breast HR = 1.96 (1.09, 3.54) among women at age ? 60 at time of RT, adjusted for history of smoking and prior MI. The adjusted HR dAMI = 1.90 (1.08, 3.35) for exposure to anterior internal mammary node (IMC) RT. Among women who received anterior left breast boost RT, increasing area of the boost is associated with adjusted HR vAMI = 1.02 (1.00, 1.03)/cm2, and adjusted HR dAMI = 1.02 (1.01, 1.03)/cm2. Conclusion: The risks of vAMI and dAMI following RT for BrCa are related to anatomic sites of RT (left breast, area of anterior left breast boost field, and anterior IMC field)

2007-03-01

254

Therapeutic implications of selecting the SCORE (European) versus the D'AGOSTINO (American) risk charts for cardiovascular risk assessment in hypertensive patients  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background No comparisons have been made of scales estimating cardiovascular mortality and overall cardiovascular morbidity and mortality. The study objectives were to assess the agreement between the Framingham-D'Agostino cardiovascular risk (CVR) scale and the chart currently recommended in Europe (SCORE) with regard to identification of patients with high CVR, and to describe the discrepancies between them and the attendant implications for the treatment of hypert...

Gómez-Marcos Manuel A; Martínez-Salgado Carlos; Martin-Cantera Carlos; Recio-Rodríguez José I; Castaño-Sánchez Yolanda; Giné-Garriga Maria; Rodriguez-Sanchez Emiliano; García-Ortiz Luis

2009-01-01

255

Predictive impact of allele-matching and EBMT risk score for outcome after T-cell depleted unrelated donor transplantation in poor-risk acute leukemia and myelodysplasia.  

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Many parameters predict for outcome after unrelated donor (URD) allogeneic hematopoietic stem cell transplantation (alloSCT). High-resolution HLA-matching significantly impacts outcome and also the European Group of Blood and Marrow Transplantation (EBMT) risk score, based on patient age, disease stage, donor type, time from diagnosis to SCT and gender combination, may predict for non-relapse mortality and overall survival (OS). We evaluated the individual and combined ...

Lodewijck, T.; Oudshoorn, M.; Holt, B.; Petersen, E. J.; Spierings, E.; Borne, P. A. Von Dem; Schattenberg, A.; Allebes, W.; Groenendijk-sijnke, M.; Duinhouwer, L.; Willemze, R.; Lowenberg, B.; Verdonck, L. F.; Meijer, E.; Cornelissen, J. J.

2011-01-01

256

Myocardial infarction accelerates atherosclerosis  

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During progression of atherosclerosis, myeloid cells destabilize lipid-rich plaque in the arterial wall and cause its rupture, thus triggering myocardial infarction and stroke. Survivors of acute coronary syndromes have a high risk of recurrent events for unknown reasons. Here we show that the systemic response to ischemic injury aggravates chronic atherosclerosis. After myocardial infarction or stroke, apoE?/? mice developed larger atherosclerotic lesions with a more advanced morphology....

2012-01-01

257

Myocardial Infarction Accelerates Atherosclerosis  

Digital Repository Infrastructure Vision for European Research (DRIVER)

During progression of atherosclerosis, myeloid cells destabilize lipid-rich plaque in the arterial wall and cause its rupture, thus triggering myocardial infarction and stroke. Survivors of acute coronary syndromes have a high risk of recurrent events for unknown reasons. Here we show that the systemic response to ischemic injury aggravates chronic atherosclerosis. After myocardial infarction or stroke, apoE\\(^{?/?}\\) mice developed larger atherosclerotic lesions with a more advanced morp...

2012-01-01

258

A novel H-FABP assay and a fast prognostic score for risk assessment of normotensive pulmonary embolism.  

Science.gov (United States)

We tested whether heart-type fatty acid binding protein (H-FABP) measured by a fully-automated immunoturbidimetric assay in comparison to ELISA provides additive prognostic value in patients with pulmonary embolism (PE), and validated a fast prognostic score in comparison to the ESC risk prediction model and the simplified Pulmonary Embolism Severity Index (sPESI). We prospectively examined 271 normotensive patients with PE; of those, 20 (7%) had an adverse 30-day outcome. H-FABP levels determined by immunoturbidimetry were higher (median, 5.2 [IQR; 2.7-9.8] ng/ml) than those by ELISA (2.9 [1.1-5.4] ng/ml), but Bland-Altman plot demonstrated a good agreement of both assays. The area under the curve for H-FABP was greater for immunoturbidimetry than for ELISA (0.82 [0.74-0.91] vs 0.78 [0.68-0.89]; P=0.039). H-FABP measured by immunoturbidimetry (but not by ELISA) provided additive prognostic information to other predictors of 30-day outcome (OR, 12.4 [95% CI, 1.6-97.6]; P=0.017). When H-FABP determined by immunoturbidimetry was integrated into a novel prognostic score (H-FABP, Syncope, and Tachycardia; FAST score), the score provided additive prognostic information by multivariable analysis (OR, 14.2 [3.9-51.4]; pFABP by immunoturbidimetry provides prognostic information superior to that of ELISA and, if integrated in the FAST score, appears more suitable to identify patients with an adverse 30-day outcome compared to the ESC model and sPESI. PMID:24477222

Dellas, C; Tschepe, M; Seeber, V; Zwiener, I; Kuhnert, K; Schäfer, K; Hasenfuß, G; Konstantinides, S; Lankeit, M

2014-05-01

259

Predicting The Risk Of Preterm Labor By Second Trimester Measurement Of Maternal A-Fetoprotein Levels And A Risk Factor Scoring System  

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Background; Preterm labor (delivery after 20 weeks and before 37 weeks of gestation) is the leading cause of prenatal mortality in developed countries.Many women who have pre term labor have abnom1ally high plasma levels of a-fetoprotein in early pregnancy.Methods: This study was designed to evaluate the ability of this biochemical test and a clinical risk factor scoring system to prospectively discriminate pregnancies at high risk for preterm delivery.In nested case control study six~hundred...

2005-01-01

260

Development and Validation of a Risk Score Predicting Substantial Weight Gain over 5 Years in Middle-Aged European Men and Women  

DEFF Research Database (Denmark)

Identifying individuals at high risk of excess weight gain may help targeting prevention efforts at those at risk of various metabolic diseases associated with weight gain. Our aim was to develop a risk score to identify these individuals and validate it in an external population.

Steffen, Annika; Sørensen, Thorkild

2013-01-01

 
 
 
 
261

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 cardiovasc...

Pita-Fernández Salvador; Pértega-Díaz Sonia; Valdés-Cañedo Francisco; Seijo-Bestilleiro Rocío; Seoane-Pillado Teresa; Fernández-Rivera Constantino; Alonso-Hernández Angel; Lorenzo-Aguiar Dolores; López-Calviño Beatriz; López-Muñiz Andres

2011-01-01

262

After myocardial infarction. How to determine future risk and what to do then.  

Science.gov (United States)

Management of the postinfarction patient should be directed toward identifying and treating individuals at risk of future coronary morbidity or mortality. The history, physical examination, resting ECG, and chest film, supplemented with ambulatory electrocardiographic monitoring, noninvasive assessment of left ventricular function, graded exercise testing, and sometimes angiography allow stratification of patients into high- and low-risk subgroups. A program of exercise training, risk factor modification, and prophylactic therapy with beta blockers would be warranted in most patients. Use of antiarrhythmic agents may alter prognosis in certain subgroups. Evidence is currently insufficient to warrant routine use of anticoagulant or antiplatelet agents in the postinfarction patient. PMID:6134274

Esterbrooks, D J; Kiefer, S; Weatherbee, T; Aronow, W S; Mohiuddin, S M; Sketch, M H

1983-06-01

263

Depressive Symptoms and Risk of New Cardiovascular Events or Death in Patients with Myocardial Infarction : A Population-Based Longitudinal Study Examining Health Behaviors and Health Care Interventions  

DEFF Research Database (Denmark)

Depressive symptoms is associated with adverse cardiovascular outcomes in patients with myocardial infarction (MI), but the underlying mechanisms are unclear and it remains unknown whether subgroups of patients are at a particularly high relative risk of adverse outcomes. We examined the risk of new cardiovascular events and/or death in patients with depressive symptoms following first-time MI taking into account other secondary preventive factors. We further explored whether we could identify subgroups of patients with a particularly high relative risk of adverse outcomes.

Larsen, Karen Kjær; Christensen, Bo

2013-01-01

264

Biomarkers of fish consumption and risk of stroke or myocardial infarction  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The effect of fish consumption on the risk of cardiovascular disease has been extensively studied. Omega-3 fatty acids present in fish, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been found to have beneficial effects through several mechanisms. In addition, selenium, an antioxidant, may be protective. Fish also represents the main human exposure source to the pollutant methylmercury (MeHg), which is associated with elevated cardiovascular risk in previous studies....

Wennberg, Maria

2010-01-01

265

Increased risk of acute myocardial infarction after the Great East Japan Earthquake.  

Science.gov (United States)

Strong psychosocial stress is considered to be a precipitating factor in acute coronary events. To assess the hypothesis that the incidence of acute myocardial infarction (AMI) and its severity was remarkably heightened after the great earthquake, we retrospectively analyzed the clinical data of patients with AMI admitted to our hospital during a 3-week period between March 11 and March 31, 2011 (disaster group) as compared with AMI patients during the corresponding time period of 2010 (non-disaster group). The number of patients with AMI in the disaster group increased by about threefold (22 in the disaster group vs. seven in the non-disaster group). Compared with the previous years 2010 or 2009, the odds ratios [OR] for AMI during a 3-week period in 2011 were 4.40 (95 % confidence interval [CI]: 1.05-18.35), 5.66 (95 % CI: 1.42-22.59), respectively. Although the number of patients who underwent coronary revascularization was higher in the disaster group than in the non-disaster group (68.2 vs. 42.9 %, p = 0.0397), peak serum creatine kinase (CK)-MB level was significantly higher in the disaster group than in the non-disaster group (208.0 ± 159.0 vs. 149.3 ± 102.7 IU/l, p = 0.0431). In the disaster group, four patients died of cardiac causes, whereas no patient died in the non-disaster group (in-hospital mortality rate in the disaster vs. non-disaster group: 18.2 vs. 0 %, p = 0.0281). These results suggest that patients with AMI after the earthquake might be subject to strong psychosocial stress, and that psychological stress brought on by such disaster could trigger cardiac events and cardiac death. PMID:23604314

Nakamura, Akihiro; Nozaki, Eiji; Fukui, Shigefumi; Endo, Hideaki; Takahashi, Tohru; Tamaki, Kenji

2014-03-01

266

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

DEFF Research Database (Denmark)

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.

Olson, Charles W; Wagner, Galen S

2014-01-01

267

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

Directory of Open Access Journals (Sweden)

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 trombo móvil en aurícula derecha con riesgo embólico pulmonar, que desapareció luego de tratamiento antiagregante plaquetario y anticoagulante.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.

Amaury Flores Sánchez

2012-03-01

268

Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english 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

Alberto, Fica; Nicolás, Bunster; Felipe, Aliaga; Felipe, Olivares; Lorena, Porte; Stephanie, Braun; Jeannette, Dabanch; Juan Carlos, Hormázabal; Antonio, Hernández; María Guacolda, Benavides.

269

Growth Factor-Induced Mobilization of Cardiac Progenitor Cells Reduces the Risk of Arrhythmias, in a Rat Model of Chronic Myocardial Infarction  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Heart repair by stem cell treatment may involve life-threatening arrhythmias. Cardiac progenitor cells (CPCs) appear best suited for reconstituting lost myocardium without posing arrhythmic risks, being commissioned towards cardiac phenotype. In this study we tested the hypothesis that mobilization of CPCs through locally delivered Hepatocyte Growth Factor and Insulin-Like Growth Factor-1 to heal chronic myocardial infarction (MI), lowers the proneness to arrhythmias. We used 133 adult male W...

2011-01-01

270

Plasma Vitamin E and Coenzyme Q10 Are Not Associated with a Lower Risk of Acute Myocardial Infarction in Singapore Chinese Adults12  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Vitamin E and coenzyme Q10 (CoQ10) have antioxidant effects that may benefit cardiovascular health. Meta-analyses of randomized controlled trials have not shown a protective effect of supplementation with the vitamin E isomer ?-tocopherol on the risk of acute myocardial infarction (AMI), but data on other isomers and CoQ10 are limited. Our objective was to examine the association of the plasma concentrations of vitamin E isomers (?-, ?-, and ?-tocopherol and ?-, ?-, and ?-tocotrienol) ...

Naidoo, Nasheen; Dam, Rob M.; Koh, Woon-puay; Chen, Cynthia; Lee, Yian-ping; Yuan, Jian-min; Ong, Choon-nam

2012-01-01

271

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  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 car...

Eb, Levitan; Gamboa C; Mm, Safford; Dv, Rizk; Tm, Brown; Ez, Soliman; Muntner P

2013-01-01

272

Polymorphisms Related to the Serum 25-Hydroxyvitamin D Level and Risk of Myocardial Infarction, Diabetes, Cancer and Mortality. The Tromsø Study  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Low serum 25(OH)D levels are associated with cardiovascular risk factors, and also predict future myocardial infarction (MI), type 2 diabetes (T2DM), cancer and all-cause mortality. Recently several single nucleotide polymorphisms (SNPs) associated with serum 25-hydroxyvitamin D (25(OH)D) level have been identified. If these relations are causal one would expect a similar association between these SNPs and health.

2012-01-01

273

Polymorphisms Related to the Serum 25-Hydroxyvitamin D Level and Risk of Myocardial Infarction, Diabetes, Cancer and Mortality. The Tromsø Study  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Low serum 25(OH)D levels are associated with cardiovascular risk factors, and also predict future myocardial infarction (MI), type 2 diabetes (T2DM), cancer and all-cause mortality. Recently several single nucleotide polymorphisms (SNPs) associated with serum 25-hydroxyvitamin D (25(OH)D) level have been identified. If these relations are causal one would expect a similar association between these SNPs and health. DNA was prepared from subjects who participated in the fourth survey of the Tro...

2012-01-01

274

Mortality from isolated coronary bypass surgery: a comparison of the Society of Thoracic Surgeons and the EuroSCORE risk prediction algorithms  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We compared the performances of the additive European System for Cardiac Operative Risk Evaluation, EuroSCORE (AES) and logistic EuroSCORE (LES) with the Society of Thoracic Surgeons' risk prediction algorithm in terms of discrimination and calibration in predicting mortality in patients undergoing isolated coronary artery bypass grafting (CABG) at a single institution in Pakistan. Both models were applied to 380 patients, operated upon at the Aga Khan University Hospital from August 2009 to ...

2012-01-01

275

Genetic score of multiple risk-associated single nucleotide polymorphisms is a marker for genetic susceptibility to bladder cancer.  

Science.gov (United States)

Genome-wide association studies have identified 13 single nucleotide polymorphisms (SNPs) that are associated with bladder cancer; three of these SNPs were validated in the Chinese population. This study assessed the performance of these three SNPs, in combination, to predict genetic susceptibility to bladder cancer in Chinese. Three previously established bladder cancer risk-associated SNPs (rs798766 in TACC3, rs9642880 in MYC, and rs2294008 in PSCA) were genotyped in 1,210 bladder cancer patients and 1,008 control subjects in Shanghai, China. A genetic score was calculated for each subject based on these three SNPs. Each of these three SNPs was significantly associated with bladder cancer risk in this independent study population, P cases than controls, with a mean of 1.05 and 0.99, respectively, P = 1.03E-05. Compared with subjects with a genetic score 1.00) had a significantly increased risk for bladder cancer after adjusting for age, gender, and smoking status, OR = 1.58, 95% Confidence Interval (CI) = 1.21 - 2.06, P = 0.0007. When tested separately for lower (Ta) or higher (Tis, T1-T4) tumor stage, the association was significantly stronger for lower (OR = 2.24, 95% CI = 1.66 - 3.01, P = 1.02E-07) than higher tumor stage (OR = 1.33, 95% CI = 1.00 - 1.78, P = 0.05), P = 0.001. In conclusion, A combination of three previously implicated bladder cancer risk-associated SNPs is a significant predictor of genetic susceptibility to bladder cancer in Chinese. PMID:24155119

Wang, Ping; Ye, Dingwei; Guo, Jianming; Liu, Fang; Jiang, Haowen; Gong, Jian; Gu, Chengyuan; Shao, Qiang; Sun, Jielin; Zheng, S Lilly; Yu, Hongjie; Lin, Xiaoling; Xia, Guowei; Fang, Zujun; Zhu, Yao; Ding, Qiang; Xu, Jianfeng

2014-01-01

276

Identification of a 20-Gene Expression-Based Risk Score as a Predictor of Clinical Outcome in Chronic Lymphocytic Leukemia Patients  

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Despite the improvement in treatment options, chronic lymphocytic leukemia (CLL) remains an incurable disease and patients show a heterogeneous clinical course requiring therapy for many of them. In the current work, we have built a 20-gene expression (GE)-based risk score predictive for patients overall survival and improving risk classification using microarray gene expression data. GE-based risk score allowed identifying a high-risk group associated with a significant shorter overall survival (OS) and time to treatment (TTT) (P ? .01), comprising 19.6% and 13.6% of the patients in two independent cohorts. GE-based risk score, and NRIP1 and TCF7 gene expression remained independent prognostic factors using multivariate Cox analyses and combination of GE-based risk score together with NRIP1 and TCF7 gene expression enabled the identification of three clinically distinct groups of CLL patients. Therefore, this GE-based risk score represents a powerful tool for risk stratification and outcome prediction of CLL patients and could thus be used to guide clinical and therapeutic decisions prospectively.

Bou Samra, Elias; Klein, Bernard; Commes, Therese; Moreaux, Jerome

2014-01-01

277

A score of risk factors associated with ischemic digital ulcers in patients affected by systemic sclerosis treated with iloprost.  

Science.gov (United States)

A single series of patients affected by systemic sclerosis (SSc) and cyclically treated with iloprost was reviewed in order to evaluate the incidence of digital ulcers (DUs) and to compare the characteristics between the patients with and without this painful and disabling vascular complication. The record charts of 85 SSc patients were revised. Ischemic DUs and scleroderma contracture ulcers were separately considered. Twenty-nine subjects developed ischemic DUs during the course of the disease; whereas, scleroderma contracture ulcers occurred in six subjects. Ischemic DUs were associated with younger age at scleroderma onset, a longer disease duration, a longer time delay from scleroderma diagnosis to iloprost therapy, a bigger skin involvement, the presence of joint contractures, a videocapillaroscopic late pattern, a history of smoking, and of corticosteroids therapy. After the exclusion of four subjects with concomitant peripheral arterial disease, a forward-stepwise logistic regression analysis showed that only four variables, i.e., age at scleroderma onset, delay in beginning iloprost therapy, history of smoking, and presence of joint contractures remained significantly associated with ischemic DUs. In a score reflecting the sum of these four risk factors, the prevalence of ischemic DUs increased progressively from the lowest to the highest value of the score. The predictivity of this model was evaluated by the receiver-operating characteristics curve, with an estimated area under the curve of 0.836 with 95% confidence interval from 0.736 to 0.937. All the patients with scleroderma contracture ulcers were characterized by both diffuse pattern of disease and positivity for anti-Scl70 antibody. In this retrospective study, scleroderma patients with ischemic DUs are characterized by early disease onset, delay in beginning iloprost therapy, smoking habit, and presence of joint contraction. A score reflecting the sum of these factors may be useful to predict the risk of developing ischemic DUs. PMID:19301062

Caramaschi, Paola; Martinelli, Nicola; Volpe, Alessandro; Pieropan, Sara; Tinazzi, Ilaria; Patuzzo, Giuseppe; Mahamid, Helal; Bambara, Lisa Maria; Biasi, Domenico

2009-07-01

278

Potassium Concentration on Admission Is an Independent Risk Factor for Target Lesion Revascularization in Acute Myocardial Infarction  

Science.gov (United States)

Background. Acute myocardial infarction (AMI) is accompanied by excessive production of catecholamines, which is characterized by a hypokalemic dip. A polymorphism of the adrenergic receptor has also been reported to be associated with target lesion revascularization (TLR) after coronary intervention. Subjects and Methods. We enrolled 276 consecutive patients with AMI within 24 hours of symptom onset, who underwent emergency coronary intervention using bare metal stents and had examinations over a 5–10-month follow-up period. The patients were divided into tertiles based on their serum potassium level on admission (low K, <3.9; mid K, ?3.9, <4.3; and high K, ?4.3). Results. Sixty-four TLRs were observed in the study. Increased potassium concentration was associated significantly with TLR. Patients in the high K group were about two and a half times more likely to have a TLR after AMI compared to those in the low K group. Multiple logistic analysis showed that potassium level on admission was an independent risk factor for TLR (odds ratio 1.69; confidence interval 1.04 to 2.74; P = 0.036). Conclusions. These findings indicated that increased potassium levels on admission might predict TLRs in AMI patients treated with bare metal stents.

Fujimoto, Kazuteru; Miyao, Yuji; Koga, Hidenobu; Ishii, Masanobu

2014-01-01

279

Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction  

Science.gov (United States)

Background Platelet-to-lymphocyte ratio (PLR) is a new prognostic marker in coronary artery disease. We aimed to evaluate the relationship between PLR and in-hospital mortality in patients with ST-elevated acute myocardial infarction (AMI). Material/Methods The present study included 636 patients with ST-elevated AMI. The study population was divided into tertiles based on their admission PLR. Patients having values in the third tertile was defined as the high PLR group (n=212) and those having values in the lower 2 tertiles were defined as the low PLR group (n=424). Results Risk factors of coronary artery disease and treatments administered during the in-hospital period were similar between the groups. Male patient ratio was found to be lower in the high PLR group (73% vs. 82.8%, p=0.004). In-hospital mortality was increased in the high PLR group when compared to the low PLR group (12.7% vs. 5.9%, p=0.004). The PLR >144 was found to be an independent predictor of in-hospital cardiovascular mortality (HR: 2.16, 95% CI: 1.16–4.0, p=0.014). Conclusions This study showed that PLR is an independent predictor of cardiovascular mortality in patients with ST-elevated AMI.

Temiz, Ahmet; Gazi, Emine; Gungor, Omer; Barutcu, Ahmet; Altun, Burak; Bekler, Adem; Binnetoglu, Emine; Sen, Hacer; Gunes, Fahri; Gazi, Sabri

2014-01-01

280

Acute brain infarction detected by CCT and stroke risk in patients with transient ischemic attack lasting <1 hour.  

Science.gov (United States)

Background and purpose: This study aimed to determine the frequency and associated factors of acute brain infarction (ABI) detected by noncontrast cranial computed tomography (CCT) in patients with transient ischemic attack (TIA) of symptom duration CCT were prospectively evaluated. Adjusted logistic regression was used to estimate odds ratios (ORs). Results: Of 1021 patients (mean age, 74.5 ± 11 years; 52% female) with TIA (symptom duration CCT at admission, 68 patients (6.7%; 95% CI, 5.3-8.3%) exhibited TIA-related ABI. Adjusted logistic regression showed that ABI was independently correlated with atrial fibrillation (AF) (OR, 3.3; 95% CI, 1.4-7.9; p = 0.006) and time between onset and CT assessment >6 h (OR, 2.5; 95% CI, 1.1-6.1; p = 0.034). During hospitalization (5 ± 3 d), 22 patients (2.2%; 95% CI, 1.4-3.1%) developed a stroke. Patients with ABI had higher stroke rates than those without (10.3% and 1.6%, respectively; p CCT in TIA patients with symptom duration CCT assessment and presence of AF. Evidence of ABI indicates an elevated stroke risk during hospitalization. PMID:24098915

Al-Khaled, Mohamed; Rauch, Linus; Roessler, Florian; Eggers, Jürgen

2014-06-01

 
 
 
 
281

Weighted Risk Score-Based Multifactor Dimensionality Reduction to Detect Gene-Gene Interactions in Nasopharyngeal Carcinoma  

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Full Text Available Determining the complex relationships between diseases, polymorphisms in human genes and environmental factors is challenging. Multifactor dimensionality reduction (MDR has been proven to be capable of effectively detecting the statistical patterns of epistasis, although classification accuracy is required for this approach. The imbalanced dataset can cause seriously negative effects on classification accuracy. Moreover, MDR methods cannot quantitatively assess the disease risk of genotype combinations. Hence, we introduce a novel weighted risk score-based multifactor dimensionality reduction (WRSMDR method that uses the Bayesian posterior probability of polymorphism combinations as a new quantitative measure of disease risk. First, we compared the WRSMDR to the MDR method in simulated datasets. Our results showed that the WRSMDR method had reasonable power to identify high-order gene-gene interactions, and it was more effective than MDR at detecting four-locus models. Moreover, WRSMDR reveals more information regarding the effect of genotype combination on the disease risk, and the result was easier to determine and apply than with MDR. Finally, we applied WRSMDR to a nasopharyngeal carcinoma (NPC case-control study and identified a statistically significant high-order interaction among three polymorphisms: rs2860580, rs11865086 and rs2305806.

Chao-Feng Li

2014-06-01

282

Modified Mediterranean Diet Score and Cardiovascular Risk in a North American Working Population  

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Introduction: Greater adherence to a Mediterranean diet is linked to lower risk for cardiovascular morbidity/mortality in studies of Mediterranean cohorts, older subjects, and/or those with existing health conditions. No studies have examined the effects of this dietary pattern in younger working populations in the United States. We investigated the effects of Mediterranean diet adherence on cardiovascular disease (CVD) biomarkers, metabolic syndrome and body composition in an occupationally ...

Yang, Justin; Farioli, Andrea; Korre, Maria; Kales, Stefanos N.

2014-01-01

283

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

LENUS (Irish Health Repository)

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.

Goldstein, James A

2012-02-01

284

A melanoma risk score in a Brazilian population Um escore de risco para melanoma em uma população brasileira  

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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.

Lucio Bakos

2013-04-01

285

Changes in medical treatment six months after risk stratification with HeartScore and coronary artery calcification scanning of healthy middle-aged subjects  

DEFF Research Database (Denmark)

Objectives: The aim was to examine and compare the impact of HeartScore and coronary artery calcification (CAC) score on subsequent changes in the use of medication. Methods: A total of 1156 healthy men and women, aged 50 or 60, had a baseline medical examination and a coronary artery CT-scan as a part of a screening programme. Using the European HeartScore, the total 10-year cardiovascular mortality risk was estimated (â?¥5% risk was considered as high). Risk factors and CAC scores were reported to both the patients and their general practitioner. Six months after the screening, follow-up questionnaires addressing current medication were mailed to the participants. Results: A completed questionnaire was returned by 1075 (93%) subjects. At follow up, the overall use of prophylactic medication was significantly increased. Of those with CAC (n = 462) or high HeartScore (n = 233), 21 and 19%, respectively, received lipid-lowering treatment, while 25 and 32%, respectively, received antihypertensive treatment. In multivariate logistic regression analyses, the presence of CAC was associated with an increased use of lipid-lowering treatment (OR 2.2; 95% CI 1.2-4.0), while the presence of a high HeartScore was associated with an increased use of lipid-lowering (OR 2.9; 95% CI 1.6-5.5) and antihypertensive medication (OR 3.4; 95% CI 1.9-6.0). Conclusion: Knowledge of present cardiovascular risk factors like high HeartScore and/or CAC leads to beneficial changes in medication. However, at follow up only a minority of high-risk subjects did received prophylactic treatment. CAC score was not superior to HeartScore regarding these motivational outcomes.

Gerke, Oke; Lambrechtsen, Jess

2012-01-01

286

Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg)  

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BACKGROUND: It has been suggested that a higher calcium intake might favourably modify cardiovascular risk factors. However, findings of an ultimately decreased risk of cardiovascular disease (CVD) are limited. Instead, recent evidence warns that taking calcium supplements might increase myocardial infarction (MI) risk.

2012-01-01

287

Use of the Diabetes Prevention Trial-Type 1 Risk Score (DPTRS) for improving the accuracy of the risk classification of type 1 diabetes.  

Science.gov (United States)

OBJECTIVE We studied the utility of the Diabetes Prevention Trial-Type 1 Risk Score (DPTRS) for improving the accuracy of type 1 diabetes (T1D) risk classification in TrialNet Natural History Study (TNNHS) participants. RESEARCH DESIGN AND METHODS The cumulative incidence of T1D was compared between normoglycemic individuals with DPTRS values >7.00 and dysglycemic individuals in the TNNHS (n = 991). It was also compared between individuals with DPTRS values 7.00 among those with dysglycemia and those with multiple autoantibodies in the TNNHS. DPTRS values >7.00 were compared with dysglycemia for characterizing risk in Diabetes Prevention Trial-Type 1 (DPT-1) (n = 670) and TNNHS participants. The reliability of DPTRS values >7.00 was compared with dysglycemia in the TNNHS. RESULTS The cumulative incidence of T1D for normoglycemic TNNHS participants with DPTRS values >7.00 was comparable to those with dysglycemia. Among those with dysglycemia, the cumulative incidence was much higher (P 7.00 than for those with values 7.00). Dysglycemic individuals in DPT-1 were at much higher risk for T1D than those with dysglycemia in the TNNHS (P 7.00. The proportion in the TNNHS reverting from dysglycemia to normoglycemia at the next visit was higher than the proportion reverting from DPTRS values >7.00 to values <7.00 (36 vs. 23%). CONCLUSIONS DPTRS thresholds can improve T1D risk classification accuracy by identifying high-risk normoglycemic and low-risk dysglycemic individuals. The 7.00 DPTRS threshold characterizes risk more consistently between populations and has greater reliability than dysglycemia. PMID:24550217

Sosenko, Jay M; Skyler, Jay S; Mahon, Jeffrey; Krischer, Jeffrey P; Greenbaum, Carla J; Rafkin, Lisa E; Beam, Craig A; Boulware, David C; Matheson, Della; Cuthbertson, David; Herold, Kevan C; Eisenbarth, George; Palmer, Jerry P

2014-04-01

288

[Evaluation of the size of thrombolysed myocardial infarction by serum myosin determination].  

Science.gov (United States)

The prognosis of myocardial infarction is very dependent on the size of the infarct. The measurement of the infarct size after thrombolysis remains difficult despite the large number of methods available, all of which have drawbacks. This parameter is however essential to assess prognosis and the efficacy of thrombolytic therapy. Serum beta heavy chain myosin determination is a recently introduced method of evaluating infarct size; there are relatively few published studies, especially concerning post-thrombolytic patients. A prospective study was undertaken in 40 patients (37 men and 3 women: average age 55.6 years) with a primary myocardial infarction treated by thrombolysis. Myosin levels (peak and area under curve of 5 samples in 10 days) were compared with other methods of assessing infarct size: electrocardiogram (number of leads with Q waves, ST segment analysis), cardiac enzymes (peak and release integrals of CK abd LDH), contrast ventriculography (segmental asynergy score, ejection fraction), coronary angiography and resting MIBI myocardial scintigraphy. The peak and integral of myosin release correlated well with the other methods (p < 0.01): a correlation was particularly apparent between the integral of myosin release and MIBI scintigraphy scores (r = 0.77, p < 0.001). Complex myosin release kinetics were observed significantly more often in patients with large infarcts (p < 0.01) or in those with occlusion of the artery responsible for infarction at coronary angiography on the 6th day (p = 0.001). In conclusion, with 5 blood samples over a 10 day period, it is possible to estimate the infarct size after thrombolysis in everyday cardiological practice: this method could help identify high risk subjects (complex kinetics of myosin release and high peak myosin levels) and also could be used to assess efficacy of thrombolytic therapy in large scale trials. PMID:1306624

Stordeur, J M; Messner, P; Bonardet, A; Kotzki, P O; Larue, C; Bertinchant, J P; Nigond, J; Grolleau, R

1992-12-01

289

Coronary calcifications in young patients with first, unheralded myocardial infarction: a risk factor matched analysis by electron beam tomography  

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Objective: To compare the presence and extent of coronary calcifications in young patients with first, unheralded acute myocardial infarction with matched controls without a history of coronary artery disease.

Pohle, K.; Ropers, D.; Ma?ffert, R.; Geitner, P.; Moshage, W.; Regenfus, M.; Kusus, M.; Daniel, W. G.; Achenbach, S.

2003-01-01

290

Renal infarction  

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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 fibri...

Saeed K

2012-01-01

291

Renal infarction  

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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

Saeed K

2012-09-01

292

Use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs in high doses increases mortality and risk of reinfarction in patients with prior myocardial infarction  

DEFF Research Database (Denmark)

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. In the present study, we analyzed the risk of rehospitalization for acute myocardial infarction (re-MI) and death related to the use of NSAIDs including selective COX-2 inhibitors in patients with a prior myocardial infarction (MI). We included 58,432 patients discharged alive after a first MI, and subsequent use of all NSAIDs was identified from a nationwide register of drug dispensing from pharmacies. We found a dose-dependent increase in risk of death for both the selective COX-2 inhibitors and the nonselective NSAIDs (all of the drugs tested). There were trends for increased risk of re-MI associated with the use of both the selective COX-2 inhibitors and the nonselective NSAIDs (high dosages). Selective COX-2 inhibitors in all dosages and nonselective NSAIDsin high dosages should be used with particular caution in patients with a prior MI Udgivelsesdato: 2008/1

Sørensen, Rikke; Abildstrøm, Steen Zabell

2008-01-01

293

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)

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 

Lønborg, Jacob; Engstrøm, Thomas

2011-01-01

294

Postpartal recurrent non-ST elevation myocardial infarction in essential thrombocythaemia: case report and review of the literature  

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Full Text Available Abstract Normal pregnancy corresponds to a procoagulant state. Acute myocardial infarction during pregnancy is rare, yet considering the low non-pregnant risk score of childbearing women it is still surprisingly frequent. We report a case of postpartum recurrent non-ST elevation myocardial infarction in a 40-year-old caucasian woman with essential thrombocythaemia in the presence of a positive JAK-2 mutation and an elevated anti-cardiolipin IgM antibody titer. In the majority of cases of myocardial infarction in pregnancy or in the peripartal period, atherosclerosis, a thrombus or coronary artery dissection is observed. The combination of essential thrombocythaemia and elevated anti-cardiolipin IgM antibody titer in the presence of several cardiovascular risk factors seems to be causative in our case. In conclusion, with the continuing trend of childbearing at older ages, rare or unlikely conditions leading to severe events such as myocardial infarction must be considered in pregnant women.

Raio Luigi

2010-06-01

295

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  

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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.

Michels Bob PJ

2008-08-01

296

The influence of polygenic risk scores on heritability of anti-CCP level in RA.  

Science.gov (United States)

The objective of this study was to study genetic factors that influence quantitative anticyclic citrullinated peptide (anti-CCP) antibody levels in RA patients. We carried out a genome-wide association study (GWAS) meta-analysis using 1975 anti-CCP+ RA patients from three large cohorts, the Brigham Rheumatoid Arthritis Sequential Study (BRASS), North American Rheumatoid Arthritis Consortium (NARAC) and the Epidemiological Investigation of RA (EIRA). We also carried out a genome-wide complex trait analysis (GCTA) to estimate the heritability of anti-CCP levels. GWAS-meta-analysis showed that anti-CCP levels were most strongly associated with the human leukocyte antigen (HLA) region with a P-value of 2 × 10(-11) for rs1980493. There were 112 SNPs in this region that exceeded the genome-wide significance threshold of 5 × 10(-8), and all were in linkage disequilibrium (LD) with the HLA- DRB1*03 allele with LD r(2) in the range of 0.25-0.88. Suggestive novel associations outside of the HLA region were also observed for rs8063248 (near the GP2 gene) with a P-value of 3 × 10(-7). None of the known RA risk alleles (?52 loci) were associated with anti-CCP level. Heritability analysis estimated that 44% of anti-CCP variation was attributable to genetic factors captured by GWAS variants. In summary, anti-CCP level is a heritable trait, and HLA-DR3 and GP2 are associated with lower anti-CCP levels. PMID:24385024

Cui, J; Taylor, K E; Lee, Y C; Källberg, H; Weinblatt, M E; Coblyn, J S; Klareskog, L; Criswell, L A; Gregersen, P K; Shadick, N A; Plenge, R M; Karlson, E W

2014-03-01

297

Development and Validation of a Risk Score Predicting Substantial Weight Gain over 5 Years in Middle-Aged European Men and Women  

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Background: Identifying individuals at high risk of excess weight gain may help targeting prevention efforts at those at risk of various metabolic diseases associated with weight gain. Our aim was to develop a risk score to identify these individuals and validate it in an external population. Methods: We used lifestyle and nutritional data from 53 degrees 758 individuals followed for a median of 5.4 years from six centers of the European Prospective Investigation into Cancer and Nutrition (EP...

Steffen, Annika; Sorensen, Thorkild I. A.; Knueppel, Sven; Travier, Noemie; Sanchez, Maria-jose; Maria Huerta, Jose; Ramon Quiros, J.; Ardanaz, Eva; Dorronsoro, Miren; Teucher, Birgit; Li, Kuanrong; Bueno-de-mesquita, H. Bas; A, Daphne; Mattiello, Amalia; Palli, Domenico

2013-01-01

298

Development and Validation of a Risk Score predicting substantial Weight Gain over 5 Years in middle-aged European Men and Women  

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Given the rapid rise in obesity prevalence around the world in recent years and the considerable strains involved with the treatment of overweight and obesity, primary prevention of weight gain is of paramount public health importance. Due to limited resources, prevention efforts might be particularly targeted to individuals at high risk of excess weight gain that may result in overweight and obesity. Therefore, the aim of the present thesis was to develop a risk score predicting risk of subs...

Steffen, Annika

2012-01-01

299

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

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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 que 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 pPURPOSE: 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 diseases 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.

Marco Aurélio Dias da Silva

1998-11-01

300

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

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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.

Fosbøl, E L; Gislason, G H

2009-01-01

 
 
 
 
301

Associated risk factors for silent cerebral infarcts in sickle cell anemia: low baseline hemoglobin, sex, and relative high systolic blood pressure  

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The most common form of neurologic injury in sickle cell anemia (SCA) is silent cerebral infarction (SCI). In the Silent Cerebral Infarct Multi-Center Clinical Trial, we sought to identify risk factors associated with SCI. In this cross-sectional study, we evaluated the clinical history and baseline laboratory values and performed magnetic resonance imaging of the brain in participants with SCA (HbSS or HbS?° thalassemia) between the ages of 5 and 15 years with no history of overt stroke or seizures. Neuroradiology and neurology committees adjudicated the presence of SCI. SCIs were diagnosed in 30.8% (251 of 814) participants who completed all evaluations and had valid data on all prespecified demographic and clinical covariates. The mean age of the participants was 9.1 years, with 413 males (50.7%). In a multivariable logistic regression analysis, lower baseline hemoglobin concentration (P < .001), higher baseline systolic blood pressure (P = .018), and male sex (P = .030) were statistically significantly associated with an increased risk of an SCI. Hemoglobin concentration and systolic blood pressure are risk factors for SCI in children with SCA and may be therapeutic targets for decreasing the risk of SCI. This study is registered at www.clinicaltrials.gov as #NCT00072761.

Sarnaik, Sharada A.; Rodeghier, Mark J.; Minniti, Caterina P.; Howard, Thomas H.; Iyer, Rathi V.; Inusa, Baba; Telfer, Paul T.; Kirby-Allen, Melanie; Quinn, Charles T.; Bernaudin, Francoise; Airewele, Gladstone; Woods, Gerald M.; Panepinto, Julie Ann; Fuh, Beng; Kwiatkowski, Janet K.; King, Allison A.; Rhodes, Melissa M.; Thompson, Alexis A.; Heiny, Mark E.; Redding-Lallinger, Rupa C.; Kirkham, Fenella J.; Sabio, Hernan; Gonzalez, Corina E.; Saccente, Suzanne L.; Kalinyak, Karen A.; Strouse, John J.; Fixler, Jason M.; Gordon, Mae O.; Miller, J. Phillip; Noetzel, Michael J.; Ichord, Rebecca N.; Casella, James F.

2012-01-01

302

Evaluation of Serum Homocysteine as an Independent Risk Factor for Myocardial Infarction in Young Patients  

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Full Text Available that damages the arterial linings, interfering with the clotting factors and oxidation of LDL. Some 10% to 20% of cases of Coronary heart disease have been linked to elevated level of serum Homocysteine. Objective: This case control study was designed to study the Homocysteine levels in young patients with MI & to carry out statistical analysis to evaluate Homocysteine as an independent risk factor for MI. Methods: The mean serum Homocysteine in patients of MI and control was calculated and its association with Total cholesterol, LDL cholesterol and HDL cholesterol. Results: The mean serum Homocysteine in case and control was 29.77 µmol / L and 11 µmol / L respectively with S.D of 6.97 µmol / L and 1.96 µmol / L respectively with a significant p value of 0.0001. The difference in Homocysteine levels observed between patients with LDL-C ? 100 mg% and those with LDL-C < 100 mg% was not significant. The difference in Homocysteine levels observed between patients with HDL-C ? 40 mg% and those with HDL-C < 40 mg% was not significant. The difference in Homocysteine levels observed between patients with S. Cholesterol ? 200 mg% and those with S. Cholesterol < 200 mg% was significant ( P value = 0.0001. Conclusion: From the above findings, in this study the low levels of LDL-C and high levels of HDL-C did not protect the patients against the Homocysteine induced coronary artery disease. Also it shows that in patients who did not have high levels of total cholesterol, the higher levels of Serum Homocysteine triggered the coronary artery disease. [Natl J of Med Res 2012; 2(4.000: 423-426

Asutosh P Chauhan

2012-08-01

303

CHADS2 and CHA2DS2-VASc scores as bleeding risk indices for patients with atrial fibrillation: the Bleeding with Antithrombotic Therapy Study.  

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The CHADS2 and CHA2DS2-VASc scores, that is, ischemic stroke risk indices for patients having atrial fibrillation (AF), may also be useful as bleeding risk indices. Japanese patients with AF, who routinely took oral antithrombotic agents were enrolled from a prospective, multicenter study. The CHADS2 and CHA2DS2-VASc scores were assessed based on information at entry. Scores of 0, 1 and ?2 were defined as the low, intermediate and high ischemic risk categories, respectively, for each index. Of 1221 patients, 873 took warfarin, 114 took antiplatelet agents and 234 took both. The annual incidence of ischemic stroke was 0.76% in the low-risk category, 1.46% in the intermediate-risk category and 2.90% in the high-risk category by CHADS2 scores, and 1.44, 0.42 and 2.50%, respectively, by CHA2DS2-VASc scores. The annual incidence of major bleeding in each category was 1.52, 2.19 and 2.25% by CHADS2, and 1.44, 1.69 and 2.24% by CHA2DS2-VASc. After multivariate adjustment, the CHADS2 was associated with ischemia (odds ratio 1.76, 95% confidence interval 1.03-3.38 per 1-category increase) and the CHA2DS2-VASc tended to be associated with ischemia (2.18, 0.89-8.43). On the other hand, associations of the indices with bleeding were weak. In conclusion, bleeding risk increased gradually as the CHADS2 and CHA2DS2-VASc scores increased in Japanese antithrombotic users, although the statistical impact was rather weak compared with their predictive power for ischemic stroke. PMID:24196199

Toyoda, Kazunori; Yasaka, Masahiro; Uchiyama, Shinichiro; Iwade, Kazunori; Koretsune, Yukihiro; Nagata, Ken; Sakamoto, Tomohiro; Nagao, Takehiko; Yamamoto, Masahiro; Gotoh, Jun; Takahashi, Jun C; Minematsu, Kazuo

2014-05-01

304

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

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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.

M. A. Ciruzzi

2002-12-01

305

Evaluating pediatric risk of mortality (PRISM) score in a pediatric critical setting: A prospective observational study in Children’s Medical Center  

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The pediatric risk of mortality (PRISM) score is a measure of illness severity based on abnormalities observed on bedside examination and laboratory assessment at pediatric Intensive care Unit (PICU) admission to predict mortality probability. Our study was performed on 205 patients who were admitted to PICU of children’s Medical center (CMC) over a period of 6 months.Data were recorded prospectively from observations at the time of admission in PICU and PRISM score was measured at admissio...

"Kadivar M; Nourbakhsh S; Nouri K; Samadi Khameneh P "

2001-01-01

306

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  

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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.

Schjerning Olsen, Anne-Marie; Fosbøl, Emil L

2011-01-01

307

Evaluating pediatric risk of mortality (PRISM score in a pediatric critical setting: A prospective observational study in Children’s Medical Center  

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Full Text Available The pediatric risk of mortality (PRISM score is a measure of illness severity based on abnormalities observed on bedside examination and laboratory assessment at pediatric Intensive care Unit (PICU admission to predict mortality probability. Our study was performed on 205 patients who were admitted to PICU of children’s Medical center (CMC over a period of 6 months.Data were recorded prospectively from observations at the time of admission in PICU and PRISM score was measured at admission (PRISMa and after 24 hours (PRISMI. The mortality probability raised from 0 at low scores, approaching 1 above a PRISM score of near 40. Based on PRISMa score of 11.36, (cut-off point, patients were divided in two groups; 71% with low risk of mortaligy, who had significant difference in length of stay in ICU, admission costs and mortality rates. Other variables such as referring from other centers, mechanical ventilation at admission, and length of stay in ICU had s significant statistical relation with mortality rate.For data obtained, observed mortality rates were near similar to predicted. Athough pre-ICU PRISM score cannot be used as a single certain predictive value, but it is useful in predicting severity of illness and mortality probablitiy. Further investigations is required to determine the effectiveness of PRISM scores in our country

"Kadivar M

2001-07-01

308

Biomarkers in acute myocardial infarction  

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Myocardial infarction causes significant mortality and morbidity. Timely diagnosis allows clinicians to risk stratify their patients and select appropriate treatment. Biomarkers have been used to assist with timely diagnosis, while an increasing number of novel markers have been identified to predict outcome following an acute myocardial infarction or acute coronary syndrome. This may facilitate tailoring of appropriate therapy to high-risk patients. This review focuses on a variety of promis...

2010-01-01

309

Metabolic syndrome and dietary components are associated with coronary artery disease risk score in free-living adults: a cross-sectional study  

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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.

Takahashi Mauro

2011-05-01

310

Spine-hip T-score difference predicts major osteoporotic fracture risk independent of FRAX(®): a population-based report from CAMOS.  

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The WHO fracture risk assessment tool (FRAX(®)) estimates an individual's 10-yr major osteoporotic and hip fracture probabilities. When bone mineral density (BMD) is included in the FRAX calculation, only the femoral neck measurement can be used. Recently, a procedure was reported for adjusting major osteoporotic fracture probability from FRAX with femoral neck BMD based on the difference (offset) between the lumbar spine and the femoral neck T-score values. The objective of the current analysis was to independently evaluate this algorithm in a population-based cohort of 4575 women and 1813 men aged 50 yr and older from the Canadian Multicentre Osteoporosis Study. For women and men combined, there was a 15% (95% confidence interval 7-24%) increase in major osteoporotic fracture risk for each offset T-score after adjusting for FRAX probability calculated with femoral neck BMD. The effect was stronger in women than men, but a significant sex interaction was not detected. Among the full cohort, 5.5% had their risk category reclassified after using the offset adjustment. Sex- and age-dependent offsets (equivalent to an offset based on Z-scores) showed improved risk classification among individuals designated to be at moderate risk with the conventional FRAX probability measurement. In summary, the T-score difference between the lumbar spine and femoral neck is an independent risk factor for major osteoporotic fractures that is independent of the FRAX probability calculated with femoral neck BMD. PMID:21723768

Leslie, William D; Kovacs, Christopher S; Olszynski, Wojciech P; Towheed, Tanveer; Kaiser, Stephanie M; Prior, Jerilynn C; Josse, Robert G; Jamal, Sophie A; Kreiger, Nancy; Goltzman, David

2011-01-01

311

Factores de riesgo de test de Apgar bajo en recién nacidos Risk factors for low Apgar score in newborns  

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Full Text Available La asfixia neonatal es una causa importante de mortalidad y secuelas neurológicas. El objetivo de nuestro estudio es identificar los factores de riesgo maternos, perinatales y neonatales asociado a un Puntaje de Apgar (PA bajo. Pacientes y Método: Se analizan los datos de 57 241 recién nacidos (RN, entre los años 1997 y 2004; los antecedentes fueron ingresados en forma prospectiva a una base de datos computacional. Se realizó un análisis multivariado con un modelo de regresión logística para identificar los factores de riesgo. Resultados: 1 167 presentaron un PA £ 3 al minuto (2,1% y 291 presentaron además un puntaje £ 5 a los 5 minutos (0,5%. Los factores de riesgo de PA bajo estadísticamente significativos fueron: RN de muy bajo peso, malformaciones congénitas mayores, RN pequeño para la edad gestacional, RN pretérmino, embarazo de 42 semanas, expulsivo prolongado, fórceps, desprendimiento placentario y líquido amniótico con meconio. Conclusiones: En este trabajo se identifican los factores de riesgo de PA bajo en nuestra población, los cuales deben ser considerados para una adecuado manejo perinatalBackground: Neonatal asphyxia is an important cause of mortality and neurological sequelaes. Objective: Identify maternal, perinatal and neonatal risk factors associated with low Apgar Score (AS. Method: A multivariate analysis using logistic regression model was performed to identify risk factors in a population of 57.241 infants, born between 1997 - 2004, whose information was recollect prospectively in a computer data base. Results: 1.167 newborns had a 1-minute AS £ 3 (2,06% and 291 presented a 5-minute AS £ 5 (0,51%. The low AS predictors, according to multivariate analysis, were: very low birth weight, prematurity, congenital malformations, low gestational age, placental abruption, 42 - weeks pregnancy, meconium stained amniotic fluid and forceps. Conclusions: Risk factors of low AS are identified in our population, essential for an adequate perinatal care

HUGO SALVO F

2007-06-01

312

Evaluation of the impact of genetic polymorphisms in glutathione-related genes on the association between methylmercury or n-3 polyunsaturated long chain fatty acids and risk of myocardial infarction: a case-control study  

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Full Text Available Abstract Background The n-3 polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid, which are present in fish, are protective against myocardial infarction. However, fish also contains methylmercury, which influences the risk of myocardial infarction, possibly by generating oxidative stress. Methylmercury is metabolized by conjugation to glutathione, which facilitates elimination. Glutathione is also an antioxidant. Individuals with certain polymorphisms in glutathione-related genes may tolerate higher exposures to methylmercury, due to faster metabolism and elimination and/or better glutathione-associated antioxidative capacity. They would thus benefit more from the protective agents in fish, such as eicosapentaenoic+docosahexaenoic acid and selenium. The objective for this study was to elucidate whether genetic polymorphisms in glutathione-related genes modify the association between eicosapentaenoic+docosahexaenoic acid or methylmercury and risk of first ever myocardial infarction. Methods Polymorphisms in glutathione-synthesizing (glutamyl-cysteine ligase catalytic subunit, GCLC and glutamyl-cysteine ligase modifier subunit, GCLM or glutathione-conjugating (glutathione S-transferase P, GSTP1 genes were genotyped in 1027 individuals from northern Sweden (458 cases of first-ever myocardial infarction and 569 matched controls. The impact of these polymorphisms on the association between erythrocyte-mercury (proxy for methylmercury and risk of myocardial infarction, as well as between plasma eicosapentaenoic+docosahexaenoic acid and risk of myocardial infarction, was evaluated by conditional logistic regression. The effect of erythrocyte-selenium on risk of myocardial infarction was also taken into consideration. Results There were no strong genetic modifying effects on the association between plasma eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury and risk of myocardial infarction risk. When eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury were divided into tertiles, individuals with GCLM-588 TT genotype displayed a lower risk relative to the CC genotype in all but one tertile; in most tertiles the odds ratio was around 0.5 for TT. However, there were few TT carriers and the results were not statistically significant. The results were similar when taking plasma eicosapentaenoic+docosahexaenoic acid, erythrocyte-selenium and erythrocyte-mercury into account simultaneously. Conclusions No statistically significant genetic modifying effects were seen for the association between plasma eicosapentaenoic+docosahexaenoic acid or erythrocyte-mercury and risk of myocardial infarction. Still, our results indicate that the relatively rare GCLM-588 TT genotype may have an impact, but a larger study is necessary for confirmation.

Norberg Margareta

2011-04-01

313

The Effect of Tobacco Control Measures during a Period of Rising Cardiovascular Disease Risk in India: A Mathematical Model of Myocardial Infarction and Stroke  

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Background We simulated tobacco control and pharmacological strategies for preventing cardiovascular deaths in India, the country that is expected to experience more cardiovascular deaths than any other over the next decade. Methods and Findings A microsimulation model was developed to quantify the differential effects of various tobacco control measures and pharmacological therapies on myocardial infarction and stroke deaths stratified by age, gender, and urban/rural status for 2013 to 2022. The model incorporated population-representative data from India on multiple risk factors that affect myocardial infarction and stroke mortality, including hypertension, hyperlipidemia, diabetes, coronary heart disease, and cerebrovascular disease. We also included data from India on cigarette smoking, bidi smoking, chewing tobacco, and secondhand smoke. According to the model's results, smoke-free legislation and tobacco taxation would likely be the most effective strategy among a menu of tobacco control strategies (including, as well, brief cessation advice by health care providers, mass media campaigns, and an advertising ban) for reducing myocardial infarction and stroke deaths over the next decade, while cessation advice would be expected to be the least effective strategy at the population level. In combination, these tobacco control interventions could avert 25% of myocardial infarctions and strokes (95% CI: 17%–34%) if the effects of the interventions are additive. These effects are substantially larger than would be achieved through aspirin, antihypertensive, and statin therapy under most scenarios, because of limited treatment access and adherence; nevertheless, the impacts of tobacco control policies and pharmacological interventions appear to be markedly synergistic, averting up to one-third of deaths from myocardial infarction and stroke among 20- to 79-y-olds over the next 10 y. Pharmacological therapies could also be considerably more potent with further health system improvements. Conclusions Smoke-free laws and substantially increased tobacco taxation appear to be markedly potent population measures to avert future cardiovascular deaths in India. Despite the rise in co-morbid cardiovascular disease risk factors like hyperlipidemia and hypertension in low- and middle-income countries, tobacco control is likely to remain a highly effective strategy to reduce cardiovascular deaths. Please see later in the article for the Editors' Summary

Basu, Sanjay; Glantz, Stanton; Bitton, Asaf; Millett, Christopher

2013-01-01

314

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  

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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

Levitan EB

2013-02-01

315

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  

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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.

Julia Tamara Alvarez Cortés

2013-01-01

316

Apgar Scores  

Science.gov (United States)

... and Beyond > Apgar Scores Ages & Stages Listen Apgar Scores Article Body As soon as your baby is ... the womb. Each characteristic is given an individual score; two points for each of the five categories ...

317

Myocardial infarction accelerates atherosclerosis.  

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During progression of atherosclerosis, myeloid cells destabilize lipid-rich plaques in the arterial wall and cause their rupture, thus triggering myocardial infarction and stroke. Survivors of acute coronary syndromes have a high risk of recurrent events for unknown reasons. Here we show that the systemic response to ischaemic injury aggravates chronic atherosclerosis. After myocardial infarction or stroke, Apoe-/- mice developed larger atherosclerotic lesions with a more advanced morphology. This disease acceleration persisted over many weeks and was associated with markedly increased monocyte recruitment. Seeking the source of surplus monocytes in plaques, we found that myocardial infarction liberated haematopoietic stem and progenitor cells from bone marrow niches via sympathetic nervous system signalling. The progenitors then seeded the spleen, yielding a sustained boost in monocyte production. These observations provide new mechanistic insight into atherogenesis and provide a novel therapeutic opportunity to mitigate disease progression. PMID:22763456

Dutta, Partha; Courties, Gabriel; Wei, Ying; Leuschner, Florian; Gorbatov, Rostic; Robbins, Clinton S; Iwamoto, Yoshiko; Thompson, Brian; Carlson, Alicia L; Heidt, Timo; Majmudar, Maulik D; Lasitschka, Felix; Etzrodt, Martin; Waterman, Peter; Waring, Michael T; Chicoine, Adam T; van der Laan, Anja M; Niessen, Hans W M; Piek, Jan J; Rubin, Barry B; Butany, Jagdish; Stone, James R; Katus, Hugo A; Murphy, Sabina A; Morrow, David A; Sabatine, Marc S; Vinegoni, Claudio; Moskowitz, Michael A; Pittet, Mikael J; Libby, Peter; Lin, Charles P; Swirski, Filip K; Weissleder, Ralph; Nahrendorf, Matthias

2012-07-19

318

A modified EBMT risk score and the hematopoietic cell transplantation-specific comorbidity index for pre-transplant risk assessment in adult acute lymphoblastic leukemia  

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Background Disease stage is the most important prognostic parameter in allogeneic hematopoietic cell transplantation (HCT) for acute lymphoblastic leukemia, but other factors such as donor/host histocompatibility and gender combination, recipient age, performance status and comorbidities need to be considered. Several scoring systems are available to predict outcome in HCT recipients; however, their prognostic relevance in acute lymphoblastic leukemia is not well defined. Design and Methods In the present study we evaluated a modified EBMT risk score (mEBMT) and the HCT-specific comorbidity index (HCT-CI) in 151 adult acute lymphoblastic leukemia patients who received allogeneic HCT from 1995 until 2007 at our center. Results Disease status was first complete remission (CR1) (47%), CR>1 (21%) or no CR (32%). Overall survival (OS) at one, two and five years was 62%, 51% and 40% and non-relapse mortality (NRM) was 21%, 24% and 32%. Median mEBMT was 3 (0–6). Higher mEBMT was associated with inferior OS (hazard ratio per score unit (HR): 1.50, P<0.001), higher NRM (HR: 1.36, P=0.042) and higher relapse mortality (HR: 1.68, P<0.001). Disease stage was the predominant prognostic factor in this score. Comorbidities were present in 71% of patients with mild hepatic disease (29%), moderate pulmonary disease (28%) and infections (23%) being the most common. Median HCT-CI was 1 (0–9). In univariate analysis a trend for inferior OS (HR: 1.08, P=0.20) and higher NRM (HR: 1.14, P=0.11) with increasing HCT-CI was observed but the level of significance was not reached. In additional analyses we found that reduced Karnofsky Performance Status (KPS) was associated with inferior OS (HR: 1.34, P=0.023) and higher relapse mortality (HR: 1.71, P=0.001) when analyzed univariately. However, KPS was associated with disease stage and significance was lost in multivariate analysis. Conclusions The mEBMT was prognostic in our patient cohort with predominant influence of disease stage, whereas a trend but no significant prognostic value was observed for the HCT-CI.

Terwey, Theis H.; Hemmati, Philipp G.; Martus, Peter; Dietz, Ekkehart; Vuong, Lam G.; Massenkeil, Gero; Dorken, Bernd; Arnold, Renate

2010-01-01

319

MYOCARDIAL INFARCTION  

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Thrombolytic therapy for Acute Myocardial Infarction has been one of the most potent treatment ever developed for conditionthat kill more patients worldwide than any other. Objective: To evaluate the benefit and efficacy or observational studies of streptokinase therapy on ST-segment elevation resolution in different types of myocardial infarction that focus especially on the younger age group less than forty years. Study design: To observe the streptokinase therapy, in ST-segment elevation r...

2011-01-01

320

SIGNIFICANCE OF FORREST CLASSIFICATION, ROCKALL’S AND BLATCHFORD’S RISK SCORING SYSTEM IN PREDICTION OF REBLEEDING IN PEPTIC ULCER DISEASE  

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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.

Edvin Hadzibulic

2007-12-01

 
 
 
 
321

Predictive Value of the Cancer of the Prostate Risk Assessment Score for Recurrence-Free Survival After Radical Prostatectomy in Korea: A Single-Surgeon Series  

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Purpose To evaluate the validity of the cancer of the prostate risk assessment (CAPRA) score, a newly developed nomogram for preoperative prediction of recurrence after radical prostatectomy, in a single institution in Korea. Materials and Methods We retrospectively studied 115 men who had undergone radical prostatectomy as the first treatment for localized prostate cancer. The validity of the CAPRA score for the prediction of recurrence-free survival (RFS) and pathologic outcome was evaluated by using Kaplan-Meier analysis and a proportional hazards regression model. A seven-group model and a three-group model were used for the results. Results None of the variables of the CAPRA score was favorable compared with the previously reported data. The three-group model was significantly related with 3- and 5-year RFS (p<0.05), but the seven-group model was not. The concordance indices of the CAPRA score were 0.74 and 0.77. Of four components excluding the clinical T stage, three independently predicted RFS (age, Gleason sum, and percentage of positive biopsies). The CAPRA score was significantly related to the margin status, extracapsular extension, and seminal vesicle invasion in both the seven- and three-group models. In the three-group model, pathologic outcomes were more strongly related, especially a higher risk of seminal vesicle invasion. Conclusions The CAPRA score showed high accuracy for predicting RFS. In particular, the three-group model was more useful for predicting RFS and pathologic outcomes. Therefore, the CAPRA score may be a useful prediction model for risk stratification and may help clinicians to develop localized prostate cancer treatment.

Seo, Won Ik; Kang, Pil Moon

2014-01-01

322

Relative prognostic value of rest thallium-201 imaging, radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring after acute myocardial infarction  

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Rest thallium-201 scintigraphy, radionuclide ventriculography and 24 hour Holter monitoring are acceptable methods to assess myocardial necrosis, performance and electrical instability. This study examined the relative value of the three tests, when obtained a mean of 7 days after acute myocardial infarction, in predicting 1 year mortality in 93 patients. Planar thallium-201 images were obtained in three projections and were scored on a scale of 0 to 4 in 15 segments (normal score = 60). Patients were classified as having high risk test results as follows: thallium score less than or equal to 45 (33 patients), left ventricular ejection fraction less than or equal to 40% (51 patients) and complex ventricular arrhythmias on Holter monitoring (36 patients). During the follow-up of 6.4 +/- 3.4 months (mean +/- SD), 15 patients died of cardiac causes. All three tests were important predictors of survival by univariate Cox survival analysis; the thallium score, however, was the only important predictor by multivariate analysis. The predictive power of the thallium score was comparable with that of combined ejection fraction and Holter monitoring (chi-square = 21 versus chi-square = 22). Thus, rest thallium-201 imaging performed before hospital discharge provides important prognostic information in survivors of acute myocardial infarction which is comparable with that provided by left ventricular ejection fraction and Holter monitoring. Patients with a lower thallium score (large perfusion defects) are at high risk of cardiac death during the first year after infarction.

Hakki, A.H.; Nestico, P.F.; Heo, J.; Unwala, A.A.; Iskandrian, A.S.

1987-07-01

323

Relative prognostic value of rest thallium-201 imaging, radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring after acute myocardial infarction  

International Nuclear Information System (INIS)

Rest thallium-201 scintigraphy, radionuclide ventriculography and 24 hour Holter monitoring are acceptable methods to assess myocardial necrosis, performance and electrical instability. This study examined the relative value of the three tests, when obtained a mean of 7 days after acute myocardial infarction, in predicting 1 year mortality in 93 patients. Planar thallium-201 images were obtained in three projections and were scored on a scale of 0 to 4 in 15 segments (normal score = 60). Patients were classified as having high risk test results as follows: thallium score less than or equal to 45 (33 patients), left ventricular ejection fraction less than or equal to 40% (51 patients) and complex ventricular arrhythmias on Holter monitoring (36 patients). During the follow-up of 6.4 +/- 3.4 months (mean +/- SD), 15 patients died of cardiac causes. All three tests were important predictors of survival by univariate Cox survival analysis; the thallium score, however, was the only important predictor by multivariate analysis. The predictive power of the thallium score was comparable with that of combined ejection fraction and Holter monitoring (chi-square = 21 versus chi-square = 22). Thus, rest thallium-201 imaging performed before hospital discharge provides important prognostic information in survivors of acute myocardial infarction which is comparable with that provided by left ventricular ejection fraction and Holter monitoring. Patients with a lower thallium score (large perfusion defects) are at high risk of cardiac death during the first year after infarction

1987-01-01

324

Scoring Subjectivity and Item Performance on Measures Used to Assess Violence Risk: The PCL-R and HCR-20 as Exemplars  

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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,…

Rufino, Katrina A.; Boccaccini, Marcus T.; Guy, Laura S.

2011-01-01

325

Decreases in Electrocardiographic R-Wave Amplitude and QT Interval Predict Myocardial Ischemic Infarction in Rhesus Monkeys with Left Anterior Descending Artery Ligation  

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Clinical studies have demonstrated the predictive values of changes in electrocardiographic (ECG) parameters for the preexisting myocardial ischemic infarction. However, a simple and early predictor for the subsequent development of myocardial infarction during the ischemic phase is of significant value for the identification of ischemic patients at high risk. The present study was undertaken by using non-human primate model of myocardial ischemic infarction to fulfill this gap. Twenty male Rhesus monkeys at age of 2–3 years old were subjected to left anterior descending artery ligation. This ligation was performed at varying position along the artery so that it produced varying sizes of myocardial infarction at the late stage. The ECG recording was undertaken before the surgical procedure, at 2 h after the ligation, and 8 weeks after the surgery for each animal. The correlation of the changes in the ECG waves in the early or the late stage with the myocardial infarction size was analyzed. The R wave depression and the QT shortening in the early ischemic stage were found to have an inverse correlation with the myocardial infarction size. At the late stage, the R wave depression, the QT prolongation, the QRS score, and the ST segment elevation were all closely correlated with the developed infarction size. The poor R wave progression was identified at both the early ischemic and the late infarction stages. Therefore, the present study using non-human primate model of myocardial ischemic infarction identified the decreases in the R wave and the QT interval as early predictors of myocardial infarction. Validation of these parameters in clinical studies would greatly help identifying patients with myocardial ischemia at high risk for the subsequent development of myocardial infarction.

Han, Pengfei; Xie, Yuping; Chen, Jianmin; Xiao, Ying; Kang, Y. James

2013-01-01

326

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

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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 a...

Dafni Chaido; Drakoulis Nikolaos; Landt Olfert; Panidis Dimitris; Reczko Martin; Cokkinos Dennis V

2010-01-01

327

Longitudinal trends in diet and effects of sex, race, and education on dietary quality score change: the Coronary Artery Risk Development in Young Adults study123  

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Background: The food supply and dietary preferences have changed in recent decades. Objective: We studied time- and age-related individual and population-wide changes in a dietary quality score and food groups during 1985–2006. Design: The Coronary Artery Risk Development in Young Adults (CARDIA) study of 5115 black and white men and women [aged 18–30 y at year 0 (1985–1986)] assessed diet at examinations at study years 0, 7 (1992–1993), and 20 (2005–2006). The dietary quality score, which was validated by its inverse association with cardiovascular disease risk, summed 46 food groups rated by investigators as positive or negative on the basis of hypothesized health effects. We used repeated-measures regression to estimate time-specific mean diet scores and servings per day of food groups. Results: In 2652 participants with all 3 diet assessments, the mean (±SD) dietary quality score increased from 64.1 ± 13.0 at year 0 to 71.1 ± 12.6 at year 20, which was mostly attributable to increased age. However, the secular trend, which was estimated from differences of dietary quality scores across time at a fixed age (age-matched time trend) decreased. The diet score was higher in whites than in blacks and in women than in men and increased with education, but demographic gaps in the score narrowed over 20 y. There tended to be increases in positively rated food groups and decreases in negatively rated food groups, which were generally similar in direction across demographic groups. Conclusions: The CARDIA study showed many age-related, desirable changes in food intake over 20 y of observation, despite a secular trend toward a lower diet quality. Nevertheless, demographic disparities in diet persist.

Sijtsma, Femke PC; Meyer, Katie A; Steffen, Lyn M; Shikany, James M; Van Horn, Linda; Harnack, Lisa; Kromhout, Daan

2012-01-01

328

Short term clinical disease progression in HIV-1 positive patients taking combination antiretroviral therapy : The EuroSIDA risk-score  

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OBJECTIVES: To derive and validate a clinically applicable prognostic score for predicting short-term disease progression in HIV-infected patients taking combination antiretroviral therapy (cART). DESIGN AND METHODS: Poisson regression was used to identify prognostic markers for new AIDS/death in patients taking cART. A score was derived for 4169 patients from EuroSIDA and validated on 5150 patients from the Swiss HIV Cohort Study (SHCS). RESULTS: In EuroSIDA, 658 events occurred during 22 321 person-years of follow-up: an incidence rate of 3.0/100 person-years of follow-up [95% confidence interval (CI), 2.7-3.3]. Current levels of viral load, CD4 cell count, CD4 cell slope, anaemia, and body mass index all independently predicted new AIDS/death, as did age, exposure group, a prior AIDS diagnosis, prior antiretroviral treatment and stopping all antiretroviral drugs. The EuroSIDA risk-score was divided into four strata; a patient in the lowest strata would have predicted chance of new AIDS/death of 1 in 801, 1in 401 and 1 in 201 within the next 3, 6 or 12 months, respectively. The corresponding figures for the highest strata were 1 in 17, 1 in 9 and 1 in 5, respectively. A single-unit increase in the risk-score was associated with a 2.70 times higher incidence of clinical progression (95% CI, 2.56-2.84) in EuroSIDA and 2.88 (95% CI, 2.75-3.02) in SHCS. CONCLUSIONS: A clinically relevant prognostic score was derived in EuroSIDA and validated within the SHCS, with good agreement. The EuroSIDA risk-score will be made available publicly via an interface that will perform all calculations for the individual. Udgivelsesdato: Sep 12

Mocroft, A; Ledergerber, B

2007-01-01

329

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)

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 density assessment.

Rubin, Katrine Hass; Abrahamsen, Bo

2013-01-01

330

Myocardial infarction and stem cells  

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Permanent loss of cardiomyocytes and scar tissue formation after myocardial infarction (MI) results in an irreversible damage to the cardiac function. Cardiac repair (replacement, restoration, and regeneration) is, therefore, essential to restore function of the heart following MI. Existing therapies lower early mortality rates, prevent additional damage to the heart muscle, and reduce the risk of further heart attacks. However, there is need for treatment to improve the infarcted area by rep...

2011-01-01

331

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)

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.

Hansen, Torben

2013-01-01

332

Genetic risk score of 46 type 2 diabetes risk variants associates with changes in plasma glucose and estimates of pancreatic β-cell function over 5 years of follow-up  

DEFF Research Database (Denmark)

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 β-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 β-cell function. Individuals who gain weight may be more susceptible to the cumulative impact of type 2 diabetes risk variants on fasting plasma glucose.

Andersson, Ehm A; Allin, Kristine Højgaard

2013-01-01

333

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)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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.

José Antonio, González Pompa; José Manuel, González Pérez.

334

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)

Full Text Available SciELO Public Health | Language: Spanish Abstract in spanish 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.

José Antonio, González Pompa; José Manuel, González Pérez.

335

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)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.

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

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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)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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.

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

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Increased risk and worse prognosis of myocardial infarction in patients with prior hospitalization for epilepsy--the Stockholm Heart Epidemiology Program.  

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The association of epilepsy with risk of acute myocardial infarction (AMI) remains uncertain, and its association with myocardial infarction prognosis has not been evaluated. In this study, we performed a population-based case-control study that included 1799 cases with first AMI and 2339 controls, frequency matched by age, sex and hospital catchment area. A history of epilepsy was identified using the Swedish hospital discharge registry. Information on lifestyle and biomarkers was determined from questionnaires and standardized clinic examinations. The cohort of cases was followed for 8 years to evaluate the relationship between epilepsy and post AMI prognosis. A diagnosis of epilepsy was associated with higher risk of incident AMI, with an odds ratio (OR) of 4.92 [95% confidence interval (CI) 2.34-10.31] after adjustment for age, gender, hospital catchment area, and education. There was a graded positive relation between number of hospitalizations for epilepsy and risk of AMI. Adjustment for smoking and levels of tissue plasminogen activator (tPA)/plasminogen activator inhibitor 1 (PAI-1) complex, von Willebrand factor and homocysteine weakened, and adjustment for high-density lipoprotein (HDL) and fibrinogen strengthened, the relationship between epilepsy and AMI. The OR for epilepsy was 4.83 (95% CI 1.62-14.43) when age, gender, hospital catchment area, education and established, clinically relevant AMI risk factors, i.e. diabetes mellitus, smoking, hypertension, physical activity, obesity, high-density lipoprotein, total cholesterol and alcohol consumption were simultaneously controlled for. Epilepsy was also associated with AMI prognosis. Multivariable adjusted hazard ratios for total and cardiac mortality and for a combined outcome of cardiac death and non-fatal reinfarction, heart failure and stroke during follow up, were 1.95 (0.70-5.43), 3.49 (1.05-11.65) and 2.39 (1.16-4.90), respectively. We conclude that epilepsy might be a risk and an adverse prognostic factor for AMI. Smoking and increase in the level of homocysteine, tPA/PAI-1 complex and von Willebrand factor are candidate mechanisms linking epilepsy to increased AMI risk. Physicians should be aware of the potential cardiovascular implications of epilepsy. PMID:19717532

Janszky, Imre; Hallqvist, Johan; Tomson, Torbjörn; Ahlbom, Anders; Mukamal, Kenneth J; Ahnve, Staffan

2009-10-01

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Lack of association of two common polymorphisms on 9p21 with risk of coronary heart disease and myocardial infarction; results from a prospective cohort study  

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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.

Hofman Albert

2008-10-01

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Association between common genetic variants of ?2A-, ?2B? and ?2C-adrenoceptors and the risk of silent brain infarction.  

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Silent brain infarction (SBI) is an asymptomatic cerebrovascular disorder. The aim of the present study was to investigate the association between adrenoceptor??2 (ADRA2) gene polymorphisms and SBI. A total of 361 patients with SBI and 467 healthy control subjects were examined. The polymerase chain reaction was performed to genotype the ADRA2A 1780G>A, ADRA2B 301?303 insertion/deletion (I/D) and ADRA2C 322?325I/D polymorphisms. The frequency of the ADRA2C 322?325I/D polymorphism was significantly different between patients with SBI and control subjects. When interaction analyses were performed for vascular risk factors, the ADRA2C 322?325ID genotype increased the risk for SBI in the presence of hypertension and elevated plasma homocysteine levels. The ADRA2C 322?325ID genotype and plasma homocysteine levels showed a significant synergistic effect for SBI. In addition, the ADRA2A 1780AA genotype was associated with elevated plasma homocysteine levels. Although further analysis of the association between ADRA2 polymorphisms and clinical risk factors of SBI is required, the present study of a limited set of SBI risk factors with ADRA2 polymorphisms provides the first evidence of the involvement of ADRA2 gene family members in the development of SBI. Further studies using larger and more heterogeneous populations are required to validate the association of ADRA2 polymorphisms with SBI. PMID:24676565

Kim, Jung O; Jeon, Young Joo; Kim, Ok Joon; Oh, Seung Hun; Kim, Hyun Sook; Shin, Byoung Soo; Oh, Doyeun; Kim, Eo Jin; Cho, Yun Kyung; Kim, Nam Keun

2014-06-01

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Dietary intake of naturally occurring plant sterols is related to a lower risk of a first myocardial infarction in men but not in women in northern Sweden.  

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Dietary intake of naturally occurring plant sterols is inversely related to serum cholesterol concentrations. Elevated serum cholesterol increases the risk of myocardial infarction (MI), but it is unknown if this can be reduced by dietary intake of naturally occurring plant sterols. Our aim was to investigate if a high intake of naturally occurring plant sterols is related to a lower risk of contracting a first MI. The analysis included 1005 prospective cases (219 women, 786 men) and 3148 matched referents (723 women, 2425 men), aged 29-73 y at baseline, from the population-based Northern Sweden Health and Disease Study. A food frequency questionnaire (FFQ) was completed at baseline. Absolute plant sterol intake was inversely related to the risk of a first MI in men (OR highest vs. lowest quartile