Biomedical subjects

M Pettinger

Publications and source records attributed to M Pettinger.

At least 19 recordsLinked to original sources

PubMed2001

Risk factors for kidney stones in older women in the southern United States.

BACKGROUND: The occurrence of kidney stones is disproportionate in the southern region of the United States. Risk factors for the occurrence of kidney stones in this geographic area have not been reported previously. METHODS: The Women's Health Initiative (WHI) is an ongoing multicenter clinical investigation of strategies for the prevention of common causes of morbidity and mortality among postmenopausal women. A case-control ancillary study was conducted on 27,410 (white or black) women enrolled in the 9 southern WHI clinical centers. There were 1,179 cases (4.3%) of kidney stones at the baseline evaluation. Risk factors for stone formation were assessed in cases versus age- and race-matched control subjects. RESULTS: Risk factors (univariate) included low dietary potassium (2,404 versus 2,500 mg/day, P = 0.006), magnesium (243 versus 253 mg/day, P = 0.003) and oxalate (330 versus 345 mg/day, P = 0.02) intake, as well as increased body mass index (28.5 versus 27.7 kg/m2, P = 0.001) and a history of hypertension (42% versus 34%, P = 0.001). A slightly lower dietary calcium intake (683 versus 711 mg/day, P = 0.04) was noted in case subjects versus control subjects, but interpretation was confounded by the study of prevalent rather than incident cases. Supplemental calcium intake >500 mg/day was inversely associated with stone occurrence. CONCLUSION: Multivariate risk factors for the occurrence of kidney stones in postmenopausal women include a history of hypertension, a low dietary intake of magnesium, and low use of calcium supplements.

Age Factors↗

PubMed2000

The importance of health insurance as a determinant of cancer screening: evidence from the Women's Health Initiative.

BACKGROUND: Amid current changes in health care access across the United States, the importance of health insurance status and insurance type relative to demographic, actual, and perceived health variables as determinants of screening for breast, colorectal, and cervical cancer is uncertain. This analysis evaluates the hypothesis that health insurance independently predicts cancer screening in the Women's Health Initia tive Observational Study cohort. METHODS: Questionnaire data from 55,278 women en rolled in the Women's Health Initiative Observational Study between September 1994 and February 1997 were analyzed by multiple logistic regression to identify predictors of self-reported mammography within 2 years, Pap smear within 3 years, and stool guaiac or flexible sigmoidoscopy within 5 years. RESULTS: Positive determinants of reporting cancer screening were age, ethnic origin, household income, educational level, family history of cancer, having a usual care provider, time since last provider visit, and insurance status and type. Smoking, diabetes, and, among older women, prior cardiovascular events were negative determinants of cancer screening. Among women younger than 65, lacking health insurance or having fee-for-service insurance was strongly associated with failure to report cancer screening, independently of having or using a usual care provider and of demographics, self-perceived health, and health characteristics. Among women 65 and older, those with Medicare alone were less likely, whereas those with Medicare + prepaid insurance were more likely, to report cancer screening. CONCLUSIONS: In the Women's Health Initiative Obser vational Study, a large, diverse group of older women, health insurance type and status were among the most important determinants of cancer screening indepen dent of demographics, chronic health conditions, and self-perceived health characteristics.

Age Factors↗

PubMed2000

Biological variability of serum and urinary N-telopeptides of type I collagen in postmenopausal women.

Measurement of N-telopeptides of type I bone collagen (NTX) provides a specific indicator of the current level of bone resorption. The biological intrasubject variability of NTX in urine and serum was studied in 277 postmenopausal women, mean age, 63.6 years +/- 10.2 (+/-SD) years. Second-morning void urine and serum specimens were collected at baseline and for two consecutive days to determine short-term variability (% CV). Long-term variability was determined by comparing NTX results at baseline and two consecutive months. Subjects were instructed to maintain current diet, lifestyle, and medications during the study. The median short-term %CV was 13.1% for urine NTX. This compared with 6.3% for serum NTX. Calculation of long-term %CV showed similar trends, with the %CV for NTX measured in serum (7.5%) lower than when measured in urine (15.6%). Using the least significant change (LSC) calculation, our data show that to be 90% confident that a decrease in NTX after initiation of antiresorptive therapy in an individual patient is not caused by variability alone, a 31 % decrease in urine NTX and a 14% decrease in serum NTX is required. As reported changes in NTX caused by antiresorptive therapy are greater than these calculations; our results support the use of either specimen to measure NTX to monitor the effect of therapy.

Aged↗

PubMed1999

Niacin treatment increases plasma homocyst(e)ine levels.

BACKGROUND: Studies have reported high levels of plasma homocyst(e)ine as an independent risk factor for arterial occlusive disease. The Cholesterol Lowering Atherosclerosis Study reported an increase in plasma homocyst(e)ine levels in patients receiving both colestipol and niacin compared with placebo. Thus the objective of this study was to examine the effect of niacin treatment on plasma homocyst(e)ine levels. METHODS: The Arterial Disease Multiple Intervention Trial, a multicenter randomized, placebo-controlled trial, examined the effect of niacin compared with placebo on homocyst(e)ine in a subset of 52 participants with peripheral arterial disease. RESULTS: During the screening phase, titration of niacin dose from 100 mg to 1000 mg daily resulted in a 17% increase in mean plasma homocyst(e)ine level from 13.1 +/- 4.4 micromol/L to 15.3 +/- 5.6 micromol/L (P <.0001). At 18 weeks after randomization, there was an absolute 55% increase from baseline in mean plasma homocyst(e)ine levels in the niacin group and a 7% decrease in the placebo group (P =.0001). This difference remained statistically significant at the end of follow-up at 48 weeks. CONCLUSIONS: Niacin substantially increased plasma homocyst(e)ine levels, which could potentially reduce the expected benefits of niacin associated with lipoprotein modification. However, plasma homocyst(e)ine levels can be decreased by folic acid supplementation. Thus further studies are needed to determine whether B vitamin supplementation to patients undergoing long-term niacin treatment would be beneficial.

Aged↗

PubMed1997

Methotrexate and cyclosporine for graft-vs.-host disease prevention: what length of therapy with cyclosporine?

One hundred three patients with leukemia, aplastic anemia, or myelodysplastic syndrome were treated by marrow transplantation from genotypically HLA-identical siblings (n = 92) or HLA haploidentical family members differing for one HLA antigen on the nonshared haplotype (n = 11). To prevent graft-vs.-host disease (GVHD), they were administered postgrafting immunosuppression with a short course of intermittent methotrexate with daily cyclosporine for no more than 11 days. Customarily, we have given cyclosporine for 180 days after transplant. In the current study, we asked whether cyclosporine could be stopped earlier without affecting the risk of chronic GVHD. By day 60, patients who never had acute GVHD, or whose acute GVHD had resolved, were randomized to have cyclosporine stopped (n = 52) or continued for the usual 180 days (n = 51). Results were analyzed with a median follow-up of 9.3 years after transplant, and showed that patients in whom cyclosporine was discontinued on day 60 had a significantly more rapid onset (p = 0.001), but not a significantly higher overall incidence of chronic GVHD than those in whom the drug was stopped on day 180 (43 vs. 54%; p = 0.26). Transplant-related mortality was comparable among patients without preceding acute GVHD, regardless of when cyclosporine was discontinued (11% for both study arms). However, transplant-related mortality appeared to increase among patients with preceding acute GVHD in whom cyclosporine was stopped by day 60 (38 vs. 17%). Results suggest that cyclosporine can safely be discontinued early in patients who never had evidence of acute GVHD, while those with preceding acute GVHD would benefit from a longer course of the drug. Because of the relatively small sample sizes, these results would best be treated as promising preliminary findings that should be confirmed in larger randomized studies.

Adult↗

PubMed1994

Simulation as a design tool for phase I/II clinical trials: an example from bone marrow transplantation.

We discuss the design and analysis of a proposed phase I/II clinical trial in bone marrow transplantation whereby dose modifications that decrease the risk of one complication increase the risk of another. Trials of this type are carried out to determine whether a dose can be found that balances the risks of each complication. Three different scenarios describing potential relationships between each risk and the treatment dose are postulated. The scenarios encompass both favorable situations in which several acceptable doses exist and unfavorable situations in which no acceptable dose exists. The operating characteristics of three sequentially developed trial designs were examined by simulation under each dose-response scenario. The first design was derived from seemingly reasonable rules, but simulations showed that performance fell far short of what was desired, thus motivating modifications. Subsequent designs showed improved performance characteristics compared to the original design. Without close examination of the operating characteristics, the original design would have been implemented, leading to high risk of an erroneous conclusion.

Bone Marrow Transplantation↗

PubMed1994

'Resistance' to unrelated, DLA-nonidentical canine marrow grafts is unrestricted by the major histocompatibility complex.

Dogs undergoing rejection of unrelated, dog leukocyte antigen (DLA)-nonidentical marrow grafts show an increase in mononuclear cell counts in the peripheral blood at 1 week after transplant. Cells are of host origin and express phenotypic and morphologic characteristics of large granular lymphocytes (LGLs). LGLs from rejecting dogs suppress in vitro growth of donor marrow colony-forming units-granulocyte/macrophage (CFU-GM) and have natural killer (NK) cell activity. The current study tested whether the marrow-suppressive activity of LGLs obtained at the time of marrow graft rejection was major histocompatibility complex (MHC)-restricted. Five dogs were in the process of rejecting their DLA-nonidentical unrelated marrow grafts after conditioning with 9.2 Gy total-body irradiation (TBI). At the time of rejection, peripheral blood mononuclear cells (PBMC) were harvested. PBMC were co-cultured with marrow obtained from the original marrow transplant donor and from other unrelated dogs that were either DLA-identical or -nonidentical with the marrow donor. A statistically significant reduction of marrow donor CFU-GM was seen when compared to results with autologous effector PBMC from the marrow donor. The number of colonies with recipient effector PBMC ranged from 8 to 75% (median 29%). No suppression was seen with PBMC effectors from unrelated DLA-identical or DLA-nonidentical dogs. Similarly, significant reductions in the number of CFU-GM compared to autologous controls were seen with effector PBMC from marrow recipients and marrow target cells, both from unrelated dogs that were phenotypically DLA-identical or -nonidentical with the marrow donor. The number of colonies ranged from 6 to 68% (median 29%) and 1 to 102% (median 20%), respectively. NK activity was present at low levels in all recipients, while specific alloantigen-primed cytotoxic T cell killing by cells obtained from the five recipients yielded cytolysis of donor PBMC in only one case, suggesting that the marrow-suppressive activity was NK cell-mediated. In conclusion, PBMC from canine marrow transplant recipients undergoing rejection of DLA-nonidentical marrow grafts suppress in vitro CFU-GM growth of marrow donor cells, and this suppression is not MHC-restricted.

Animals↗

PubMed1993

FK-506 and methotrexate prevent graft-versus-host disease in dogs given 9.2 Gy total body irradiation and marrow grafts from unrelated dog leukocyte antigen-nonidentical donors.

FK-506 was evaluated either alone or combined with methotrexate (MTX) for prevention of graft-versus-host disease (GVHD) in dogs given 9.2 Gy total body irradiation and dog leukocyte antigen-nonidentical unrelated marrow grafts. Studies with marrow autografts showed gut toxicity and weight loss to be major side effects of FK-506. There was no hematopoietic toxicity with FK-506. In an initial allograft study, 5 dogs were given FK-506 intramuscularly at 0.3 mg/kg/day from days 0 to 8 and then orally at 0.5 mg/kg/day. All 5 died, 3 with intussusception most likely due to FK-506 toxicity, 1 with graft failure, and 1 with GVHD. Subsequently, the FK-506 dose was reduced and these drug schedules were used: FK-506 days 0-8 at 0.15 mg/kg/day i.m. and then orally at 0.5 mg/kg/day until day 90, with or without MTX intravenously at 0.4 mg/kg days 1, 3, 6, and 11. Twenty allografts were done, 10 with FK-506 alone, and 10 with MTX/FK-506. Results were compared with those in concurrent and historical controls given either no immunosuppression (n = 64), MTX (n = 114), CsA (n = 15), or MTX/CsA (n = 17). Five of 20 current dogs died with intussusception, too early to be evaluated for GVHD. The 10 dogs given FK-506 alone survived significantly better than those not given immunosuppression but not differently from those given short-term MTX or CsA alone. Three died from toxicity, 2 with graft failure, and 4 with GVHD. Only 1 dog became a long-term survivor, and this dog inadvertently received a single dose of MTX on day 7. Two of 10 dogs given MTX/FK-506 died from toxicity, 1 died with graft failure, 2 died with GVHD, and 5 became long-term survivors, a result that is significantly better than seen with either drug alone and similar to that seen with MTX/CsA. Four of the 5 survivors had no clinical GVHD. FK-506 blood levels were 15-35 ng/ml between days 8 and 15, when gut toxicity was most severe. Thereafter, levels were approximately 5 ng/ml. In conclusion, FK-506 prolonged survival of recipients of dog leukocyte antigen-nonidentical unrelated marrow grafts. When FK-506 was combined with MTX, graft-host tolerance was induced in 50% of dogs, even though FK-506 was stopped on day 90.

Animals↗

PubMed1993

Summarizing data on survival, relapse, and chronic graft-versus-host disease after bone marrow transplantation: motivation for and description of new methods.

Kaplan-Meier curves are frequently used to summarize survival, relapse, and chronic graft-versus-host disease (GVHD) data in the bone marrow transplant setting. Some fundamental problems with the use of Kaplan-Meier curves for the summary of relapse and GVHD are described. Alternatively, the use of simple probability and conditional probability curves for summarizing relapse incidence and transplant-related mortality is illustrated with previously published data from a randomized clinical trial. Prevalence curves provide an appropriate alternative for the summary of a transient condition such as chronic GVHD. When combined with Kaplan-Meier curves for survival and/or relapse-free survival, these methods provide a more accurate and comprehensive summary of the various marrow transplant outcomes. These methods of display are also applicable to other settings where more than one type of treatment failure can occur and where follow-up time may be variable.

Bone Marrow Transplantation↗

PubMed1992

Acute graft-versus-host disease: analysis of risk factors after allogeneic marrow transplantation and prophylaxis with cyclosporine and methotrexate.

Previous studies of risk factors for acute graft-versus-host disease (GVHD) involved patients receiving predominantly single-agent prophylaxis. Therefore, a retrospective analysis was performed on 446 patients, from a single institution, who received transplants of marrow from HLA-identical siblings and the combination of cyclosporine (CSP) and methotrexate (MTX) to determine risk factors for acute GVHD associated with this more effective form of GVHD prophylaxis. The incidences of Grades II-IV and Grades III-IV (severe) acute GVHD were 35% and 16%, respectively. Increased clinical grades of acute GVHD in patients without advanced malignant disease were associated with a decreased survival. In a multivariate Cox regression analysis, risk factors associated with the onset of Grades II-IV acute GVHD were sex mismatch and donor parity (P = .001), increased dose of total body irradiation (TBI) (P = .001), and reduction to less than 80% of the scheduled dose of MTX (P = .02) or CSP (P = .02). The multivariate analysis indicated a relative risk of 1.37 for acute GVHD in a group defined as having advanced malignant disease at transplant; however, this difference failed to reach conventional levels of statistical significance (P = .07). Reduction of MTX and CSP occurred in up to 36% and 44% of patients, respectively, primarily because of renal or hepatic dysfunction. The periods of increased risk for the onset of acute GVHD were up to 1 week after a reduction of MTX and 2 weeks after a reduction in CSP. When only patients who developed Grades II-IV acute GVHD were considered, the more severe acute GVHD of Grades III-IV was associated with increased patient age of 40 years or greater (P = .05) and dose reductions of CSP (P = .008). Serologic status of patient and donor for cytomegalovirus (CMV), HLA antigens in the A and B loci, and isolation in a laminar air flow room during marrow transplantation, all previously identified as risk factors for acute GVHD, were not confirmed as risk factors in this study population. The toxicity of MTX and CSP and the development of acute GVHD from inadequate immunosuppression because of dose reduction warrants further trials with potentially less toxic immunosuppressive agents. Risk factors for acute GVHD should be considered in clinical management and in the design of clinical trials.

Adult↗

PubMed1992

Cytomegalovirus antigen detection in peripheral blood leukocytes after allogeneic marrow transplantation.

Detection of cytomegalovirus (CMV) antigenemia was compared with shell vial centrifugation cultures for rapid detection of CMV infection. In a prospective study, 59 CMV seropositive patients were monitored weekly during the first 100 days after allogeneic marrow transplantation for virus excretion from urine, throat, and blood and for antigenemia by direct staining of peripheral leukocytes using an antibody pool directed against pp 65. Antigenemia was present in 21 of 22 patients with culture-proven CMV infection and in 3 of 37 without culture-proven CMV infection (sensitivity 95%, specificity 91%). The median time of onset of antigenemia and shell vial cultures was day 47 and 55 after transplant, respectively (P = .0006). Among patients who developed CMV disease without preceding cultures, antigenemia was detected in all patients with CMV pneumonia (N = 6) and in two of three patients with gastrointestinal disease by a median of 10 and 7 days, respectively, before the onset of disease (P = .0002). Levels of antigenemia were significantly higher in patients with disease or viremia than in patients with excretion from urine or throat (P less than .05). Whether the antigenemia assay is more sensitive than rapid culture methods to focus antiviral prophylaxis in marrow transplant patients must be determined in controlled studies.

Antigens, Viral↗

PubMed1990

Ten-year follow-up of survival and myocardial infarction in the randomized Coronary Artery Surgery Study.

The Coronary Artery Surgery Study (CASS) randomized 780 patients to an initial strategy of coronary surgery or medical therapy. Of medically randomized patients, 6% had surgery within 6 months and a total of 40% had surgery by 10 years. At 10 years, there was no difference in cumulative survival (medical, 79% vs. surgical, 82%; NS) and no difference in percentage free of death and nonfatal myocardial infarction (medical, 69% vs. surgical, 66%; NS). Patients with an ejection fraction of less than 0.50 exhibited a better survival with initial surgery treatment (medical, 61% vs. surgical, 79%; p = 0.01). Conversely, patients with an ejection fraction greater than or equal to 0.50 exhibited a higher proportion free of death and myocardial infarction with initial medical therapy (medical, 75% vs. surgical, 68%; p = 0.04) although long-term survival remained unaffected (medical, 84% vs. surgical, 83%; p = 0.75). There were no significant differences either in survival and freedom from nonfatal myocardial infarction, whether stratified on presence of heart failure, age, hypertension, or number of vessels diseased. Thus, 10-year follow-up results confirm earlier reports from CASS that patients with left ventricular dysfunction exhibit long-term benefit from an initial strategy of surgical treatment. Patients with mild stable angina and normal left ventricular function randomized to initial medical treatment (with an option for later surgery if symptoms progress) have survival equivalent to those patients randomized to initial surgery.

Coronary Artery Bypass↗

PubMed1989

Comparison of coronary angioplasty with medical treatment for single- and double-vessel coronary disease with left anterior descending coronary involvement: long-term outcome based on an Emory-CASS registry study.

The 3 to 5-year clinical outcomes of 627 consecutive patients selected for treatment with percutaneous transluminal coronary angioplasty (PTCA) at Emory University Hospital for one- or two-vessel coronary artery disease with involvement of the left anterior descending coronary artery, between July 1981 and June 1983, and 865 patients in the Coronary Artery Surgery Study with similar coronary artery disease involvement selected for medical therapy between 1975 and 1979 were compared. Cox analyses and stratified life table analyses were used to adjust for differences in 13 variables including concurrent medical therapy. Complete follow-up was obtained in 97% of PTCA patients and 99% of medically treated patients. After correction for baseline differences in significantly predictive variables, there was no difference between the relative risk of death after PTCA vs medical therapy (RR = 0.7; p = 0.36). However, results of analysis of prospectively defined subsets showed a potential survival benefit after PTCA for patients with an ejection fraction less than 50% (RR = 0.2; p = 0.02) and also for patients with two-vessel disease (RR = 0.2; p = 0.04). For the groups as a whole there was no difference in risk of infarction after PTCA and medical therapy (RR = 0.8; p = 0.58). However, for patients with 90% to 99% LAD stenosis there was a trend toward lessened risk of infarction after PTCA (RR = 0.6; p = 0.15). No patient subset had a higher risk of death or infarction with PTCA (p less than or equal to 0.15). The likelihood of later surgery was increased after PTCA (RR = 1.5; p = 0.002). Angina, employment, and activity levels were improved after PTCA. Thus PTCA compared to medical therapy was associated with improved functional status and may decrease the risk of death and infarction in certain patient subsets. However, bypass surgery was more often performed in patients initially treated with PTCA. These data should be interpreted in light of their nonrandomized study origin and generation from different clinical sites.

Activities of Daily Living↗

PubMed1988

The prevalence of steal-prone coronary anatomy in patients with coronary artery disease: an analysis of the Coronary Artery Surgery Study Registry.

Coronary steal requires a specific anatomic arrangement of coronary occlusion, collateral vessels, and stenosis of the artery supplying the collaterals. The prevalence of this anatomic variant, steal-prone coronary anatomy, was investigated in 16,249 patients with coronary artery disease whose angiograms were carefully recorded as part of the Coronary Artery Surgery Study (CASS). Almost half of the angiograms had one or more total occlusions, and, of these, about 80% had angiographically visible collateral supply to the area distal to the occlusion. Of subjects with an occlusion and collaterals, about 60% had a hemodynamically significant stenosis of the artery supplying the collateral vessels. In summary, 23% of the patients in the CASS Registry demonstrated steal-prone coronary anatomy. Thus, coronary steal could possibly affect almost a quarter of the patients with coronary artery disease having anesthesia. Studies that seek clinical evidence of harm from coronary steal must be done in that subset of patients with coronary artery disease with steal-prone anatomy.

Angiography↗

PubMed1988

Clinical implications of internal mammary artery bypass grafts: the Coronary Artery Surgery Study experience.

From the Coronary Artery Surgery Study Registry, all patients undergoing initial bypass surgery procedures with independent vein grafts were identified. The 950 patients receiving an internal mammary artery bypass graft were compared with the 6027 patients receiving vein graft alone. Improved survival rates with internal mammary artery grafts were noted at hospitals in which these grafts were performed infrequently as well as those in which the internal mammary artery graft was used frequently. The improved survival was noted in patients with normal (p = .004) as well as impaired (p = .004) ventricular function, in men (p = .0001) as well as women (p = .005), in patients over age 65 (p = .01) as well as younger patients (p less than .0001), and in those with (p = .05) or without (p less than .0001) critical stenosis of the left main coronary artery. The internal mammary artery bypass graft was an independent predictor of survival (p = .0004) and reduced the risk of dying by a factor of 0.64. It was concluded that the internal mammary artery graft is the bypass vessel of choice and should not be denied any subgroup.

Blood Vessel Prosthesis↗

PubMed1988

ST segment elevation with exercise: a marker for poor ventricular function and poor prognosis. Coronary Artery Surgery Study (CASS) confirmation of Seattle Heart Watch results.

The functional and prognostic significance of exercise-induced ST elevation (by computer averaging) in ambulatory patients with coronary heart disease was recently reported for 181 patients in the Seattle Heart Watch (SHW). To further evaluate this, 3050 approximately similar patients enrolled in CASS were analyzed with respect to initial findings, survival, and incidence of secondary coronary events over the next 6 years. The ST elevation responses in CASS patients were classified by visual interpretation of 1 mm or more, whereas the SHW patients were identified by voltage greater than 0 mV. Accordingly, prevalence of exercise-induced ST elevation was lower in CASS patients, but they had greater frequencies of prior myocardial infarction and left ventricular enlargement and dysfunction. The poor survival was similar in the subgroup with ST elevation during exercise and recovery in CASS and SHW. Although not an independent predictor when invasive variables are known, ST elevation emerges as a useful predictor when exercise testing is performed before diagnostic invasive studies.

Coronary Disease↗

PubMed1986

Should airline pilots be eligible to resume active flight status after coronary bypass surgery?: a CASS registry study.

Medical certification to return to work after coronary bypass surgery in occupations that carry a risk to public safety is controversial, particularly for airline pilots. To address this issue, 10,312 patients from the CASS registry who underwent coronary bypass surgery were studied and 2,326 men with clinical and postoperative characteristics similar to those of the average airline pilot who might apply to renew his license after surgery were selected. The 5 year probability of remaining free of an acute cardiac event, defined as acute coronary insufficiency, myocardial infarction or sudden death, was 0.92 +/- 0.01 (mean +/- SE) for the 1,207 men without previous myocardial infarction and 0.98 +/- 0.01 for the 122 men who never smoked and did not have a history of hypertension. Among the 1,119 men with a previous myocardial infarction, the probability of remaining free of acute cardiac events was 0.91 +/- 0.02 and 0.92 +/- 0.02 when left ventricular contraction score was 5 to 9 and 10 or greater, respectively. In this patient subgroup, mortality rate was similar to that of the age-matched U.S. male population when the left ventricular contraction score was 5 to 9 (4.0% versus 4.3%; p = NS) but significantly worse when the left ventricular contraction score was 10 or greater (7% versus 4.2%; p = 0.05). The data from this CASS registry study are pertinent to the question of operationally unlimited first-class medical certification of carefully selected airline pilots after coronary bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1986

The effect of medical and surgical treatment on subsequent sudden cardiac death in patients with coronary artery disease: a report from the Coronary Artery Surgery Study.

The effect of medical and surgical treatment on subsequent sudden cardiac death was assessed in 13,476 patients in the Coronary Artery Surgery Study registry who had significant coronary artery disease, operable vessels, and no significant valvular disease. (Patients were assigned to medical or surgical therapy on the basis of clinical judgment and not according to a randomization scheme; therefore, biases associated with unknown variables could not be evaluated.) Sudden cardiac death occurred in 452 patients (3.4%) during a mean follow-up of 4.6 years. Five year survival free of sudden death for medically treated patients was 94 +/- 0.3%, and that for surgically treated patients was 98 +/- 0.2% (p less than .0001). Twelve baseline clinical, electrocardiographic, and angiographic variables were significantly different between patients alive at the last follow-up and those suffering sudden death. Data on these variables were available for 11,508 patients. Sudden death occurred in 257 (4.9%) of 5258 medically treated and 101 (1.6%) of 6250 surgically treated patients. In a high-risk patient subset with three-vessel disease and history of congestive heart failure, 91% of surgically treated patients had not suffered sudden death compared with 69% of medically treated patients. After Cox survival analysis was used to correct for baseline variables, surgical treatment had an independent effect on sudden death (p less than .0001). This reduction was most pronounced in high-risk patients.

Coronary Artery Bypass↗