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Biomedical subjects

C R Conti

Publications and source records attributed to C R Conti.

At least 109 records · Page 6Linked to original sources
PubMed1996

Factors limiting the enrollment of women in a randomized coronary artery disease trial. The Asymptomatic Cardiac Ischemia Pilot Study (ACIP) Investigators.

BACKGROUND AND HYPOTHESIS: Although it is recognized that women have been underrepresented in clinical trials of cardiovascular disease, the reasons for their limited enrollment have not been elucidated. METHODS: A prospective tracking system was established in the Asymptomatic Cardiac Ischemia Pilot study (ACIP) to monitor recruitment and identify protocol issues that interfered with the recruitment of women. Patients with stress test evidence for ischemia during the course of routine clinical care were screened for asymptomatic ischemia with an ambulatory electrocardiogram (ECG). RESULTS: Those with at least one episode of asymptomatic ischemia and angiographic evidence of coronary artery disease suited for revascularization could be randomized. Women comprised only 17% of the 1,820 patients screened for asymptomatic ischemia, and only 14% of the 558 patients randomized. The limited number of women screened for ischemia was largely due to the limited number of women (25% of all patients) found to have test evidence for ischemia or coronary artery disease suited for revascularization during the course of routine clinical care. Once patients were identified as having ischemia on stress test and ambulatory ECG, the major difference in eligibility was the difference in disqualifying angiograms, occurring 21/2 times as frequently in women as in men (p < 0.001). CONCLUSION: The percentage of women recruited was lower than the prevalence of ischemic heart disease in the general population because at participating centers (1) women were found to have ischemia less often than men during the course of routine clinical care, and (2) screening tests for ischemia were less predictive of protocol-defined coronary disease in women than in men.

Analysis of Variance↗
PubMed1996

Clinical trials: are they really useful for clinical decision making?

I have always maintained that clinical trials are important to provide prognostic information in patients with cardiac disease. However, clinical trials provide prognostic information for the population of patients under study. I still believe that clinical trials provide knowledge and information that improves patient care. As physicians, we should use the results of clinical trials as guidelines for decision making in individual patients. If we are to make clinical decisions based on results of clinical trials, then it is imperative that the patient would have been suitable for entry into that clinical trial. Thus, as always, additional factors remain important when one has to determine the appropriate therapy for any single patient. These factors include persistent symptoms despite aggressive therapy, objective evidence of end points such as recurrent myocardial ischemia, life-threatening arrhythmias, ventricular dsyfunction, and presence of absence of factors that would suggest one therapy or another-for example, coronary artery spasm. If the patient has coronary artery disease, the location and severity of the coronary artery stenosis certainly influences decisions about medical or revascularization therapy, as do the confidence and enthusiasm of the surgeon and the desires of the patient.

Cardiovascular Diseases↗
PubMed1996

Transesophageal echocardiographic guidance of transseptal left heart catheterization during radiofrequency ablation of left-sided accessory pathways in humans.

UNLABELLED: Radiofrequency ablation (RFA) of left-sided accessory pathways can be achieved using catheters introduced by a retrograde or transseptal approach. Transesophageal echocardiography (TEE) has previously been demonstrated to be safe and efficacious in guiding transseptal puncture in patients during mitral valvuloplasty (MV). This study was undertaken to assess the feasibility, safety, and clinical utility of TEE during transseptal puncture and RFA of left-sided accessory pathways. METHODS: TEE was performed during transseptal puncture in 30 patients (41 +/- 12 years, 19 females), 15 patients during attempted RFA of a left-sided accessory pathway and 15 patients during attempted balloon MV. RESULTS: There was no difference in age, sex distribution, or procedural complications when MV patients were compared to RFA patients. At baseline, left atrial dimension was increased and congestive heart failure was more common when MV patients were compared to RFA patients (P < 0.05) Adequate baseline two-dimensional and Doppler TEE images were obtained in all patients. One patient sustained mild esophageal bleeding during the TEE. Positioning of the transseptal catheter in the fossa ovalis was facilitated and confirmed by TEE in 29 of 30 cases. One case of cardiac perforation occurred and was associated with inadequate TEE localization of the fossa ovalis. Thrombus was detected on the transseptal catheter by TEE in two cases prior to systemic heparinization. In both cases, thrombus was removed without embolic event. CONCLUSIONS: TEE safely guides transseptal puncture in patients undergoing RFA of left-sided accessory pathways. TEE markers of the fossa ovalis facilitate puncture and may reduce the risk of cardiac perforation particularly in patients with a normal size left atrium. TEE may be especially valuable for identifying thrombus during transseptal puncture.

Adolescent↗
PubMed1995

Unstable angina: cost of conservative and invasive strategies using TIMI3 B as a model.

Obviously, conservative therapy would be less expensive than invasive therapy if patients were held in the conservative category and received only medical therapy along with exercise test with thallium. However, based on the TIMI 3 B outcomes, costs are similar (but not equal) even if one attempts a conservative strategy since a significant number of patients in the early conservative arm underwent angiography (64 patients) and PTCA (26 patients) or surgery (24 patients) and the number of days for rehospitalization was greater in the early conservative than in the early invasive group. I believe the TIMI 3 B study reflects the reality of clinical practice in 1995. It seems to me that either strategy is acceptable both from the medical and economic outcome standpoints. Given the model used here, I do not think that the early invasive strategy will ever be cheaper than the early conservative strategy unless all of the patients in the early conservative strategy who eventually are revascularized have CABG, and all of the patients in the early invasive strategy who are revascularized have PTCA.

Angina, Unstable↗
PubMed1995

Management of myocardial infarction patients with an occluded infarct-related artery: additional commentary.

The evidence is becoming stronger (but not conclusive) that restoration of flow in the infarct-related artery at a later date than is generally accepted might decrease mortality. The CORAMI report suggests a good outcome with rescue angioplasty, but, unfortunately, there was no control group. Since urgent rescue PTCA opened the infarct-related artery in the 29% of patients who remained occluded after thrombolysis, those cardiologists advocating emergency PTCA in all infarcting patients argue that 100% of occluded vessels can be opened with PTCA. I don't argue that fact but would point out that 71% of these same patients would have had unnecessary angioplasty since the occluded artery would have opened with thrombolytic therapy. The randomized trial performed by Ellis and colleagues was a difficult one because of physician bias. It took three years to complete at 20 sites, and in the presence of an occluded anterior descending coronary artery some investigators were reluctant to randomize all of their patients to conservative therapy. Obviously, a large trial would be appropriate to confirm Ellis and colleagues' observations but I doubt this will ever be done. Based on what is now known, I think it is worthwhile to consider rescue angioplasty in patients with a known occluded infarct-related artery. Unfortunately, that means performing coronary angiography almost immediately in all patients with infarcting myocardium in order to identify those with persistant occlusion.

Adrenergic beta-Antagonists↗
PubMed1995

Transesophageal echocardiography in the evaluation of cardiac myxoma: a case of familial myxoma.

The vast majority of atrial myxomas are readily apparent on standard transthoracic echocardiography. We present the case of a young woman with known history of familial myxoma, in whom a large left atrial mass was identified on transthoracic echocardiography. Transesophageal study more clearly delineated the extent and origin of the tumor. In addition, an unsuspected tumor in the right ventricle was also identified. These findings were confirmed at surgery, and both masses were excised. The advantages of transesophageal echocardiography in evaluation and management of this unusual subset of patients with cardiac tumor are discussed.

Adult↗