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PubMed2003

Using rough sets, neural networks, and logistic regression to predict compliance with cholesterol guidelines goals in patients with coronary artery disease.

Coronary artery disease is a leading cause of death and disability in the United States and throughout the developed world. Results from large randomized, blinded, placebo-controlled trials have demonstrated clearly the benefit of lowering LDL cholesterol in lowering the risk for coronary artery disease. Unfortunately, despite the quantity of evidence, and the availability of medications that can efficiently lower LDL cholesterol with few side effects, not everyone who could benefit from cholesterol lowering interventions actually receives them. Despite the dissemination of national care guidelines for the evaluation and treatment of cholesterol levels (NCEP - National Cholesterol Education Program), compliance with such guidelines is suboptimal. There clearly is room for improvement in narrowing the gap between evidence based guidelines and actual clinical practice. The ability to classify those patients who are or will likely to be noncompliant on the basis of patient data routinely collected during patient care could be potentially useful by enabling the focusing of limited health care resources to those who are or will be at high risk of being under treated. In order to explore this possibility further, we attempted to create such classifiers of cholesterol guideline compliance. To do this, we obtained data from an ambulatory electronic medical record system at use at the MGH adult primary care practices for over 20 years. We obtained the data from this hierarchically-structured EMR using its own native query language, called MQL (Medical Query Language). Next, we applied to the collected data the machine learning techniques of rough set theory, neural networks (feed forward backpropagation nets), and logistic regression. We did this by using commonly available software that for the most part is freely available via the internet. We then compared the accuracy of the classifier models using the receiver operating characteristic (ROC) area and C-index summary metrics.

Cholesterol↗

PubMed1985

The significance of psychosocial factors in predicting coronary disease in patients with valvular heart disease.

Several prognostic indices for predicting various aspects of coronary artery disease were significantly improved by the inclusion of psychosocial factors. 218 patients with valvular heart disease who had undergone routine coronary arteriography before valve replacement were studied in terms of cigarettes smoked, family history of ischaemic heart disease, HDL:cholesterol ratio, angina, sex, blood pressure and four psychosocial characteristics (i.e. social support, work stress, life events and Type A behavior). It was found that the psychosocial factors improved the preoperative predictive power of significant coronary artery disease on four criteria: previous history of hypertension, previous history of myocardial infarction, signs of peripheral vascular disease and ECG evidence of myocardial infarction.

Angina Pectoris↗

PubMed1999

Comparison of the Diamond-Forrester method and a new score to estimate the pretest probability of coronary disease before exercise testing.

OBJECTIVE: We compared the Diamond-Forrester (DF) tabular method to assess pretest probability of coronary artery disease to a new scoring method (NS). METHODS: We evaluated 544 patients with suspected coronary disease who underwent both exercise electrocardiography and coronary angiography. The prevalence of any coronary artery disease (CAD) (>/=1 vessel with a >/=50% stenosis) within low, intermediate, and high pretest probability groups defined by the 2 methods was compared. The DF method used age, sex, and symptoms. The NS used those 3 factors plus 7 other risk factors. RESULTS: Overall prevalence of CAD was 41%. We compared the respective prevalence of CAD within pretest probability groups. Low probability: DF 27% versus NS 17% (P <.03); intermediate probability: DF 42% versus NS 47%; high probability: DF 70% versus NS 72%. We evaluated results separately in men and women. In women, no significant differences were found. However, in men, a significant difference in the low probability group was found (DF 47% versus NS 22%; P <.03). When the 47 asymptomatic patients were removed from the analysis, there were no differences between the 2 methods. Men: low probability, DF 17% versus NS 21%; intermediate probability, DF 45% versus NS 49%; high probability, DF 67% versus NS 72%. Women: low probability, DF 17% versus NS 15%; intermediate probability, DF 38% versus NS 27%; high probability, DF 83% versus NS 70%. CONCLUSION: In symptomatic patients, the accuracy of the 2 methods was the same. In asymptomatic patients, further evaluation in larger populations will be needed.

Coronary Angiography↗

PubMed1988

Dipyridamole-thallium 201 scintigraphy in the early post-infarction period. (Safety and accuracy in predicting the extent of coronary disease and future recurrence of angina in patients suffering from their first myocardial infarction).

To evaluate the safety and usefulness of myocardial thallium-201 scintigraphy after intravenous dipyridamole during the early post-infarction period, 35 patients under 60 years of age and with recent first transmural uncomplicated myocardial infarction (27 inferior, 8 anterior) were examined between the 5th and 13th day of hospitalization. Although four patients experienced angina and transient ischemic ST depression during the test, there were no serious complications. Patients were followed for a mean period of 11.4 +/- 6.3 months after hospital discharge. None of the patients experienced recurrent infarction and there were no cardiac deaths. In 11 patients there were reversible perfusion defects in areas different from those of myocardial infarction. Of these patients, seven (one with infarct vessel stenosis only and six with multivessel coronary disease) developed angina during the follow-up: five underwent coronary surgery because of severe angina refractory to full medical therapy. Out of the 24 patients without reversible perfusion defects, only two (with multivessel coronary disease) showed typical angina symptoms. The presence of redistribution on thallium scans was significantly more frequent in patients who developed a recurrence of angina over a period of 11.4 +/- 6.3 months of follow-up (P less than 0.0005). Thus dipyridamole-thallium 201 scintigraphy is a safe, non-invasive stress test which may be used early following uncomplicated myocardial infarction in order to identify patients at risk for the recurrence of angina.

Adult↗

PubMed1990

Percutaneous transluminal angioplasty in patients with multivessel coronary disease: how important is complete revascularization for cardiac event-free survival?

The relative influences of revascularization status and baseline characteristics on long-term outcome were examined in 867 patients with multivessel coronary disease who had undergone successful coronary angioplasty. These patients represented 83% of a total of 1,039 patients in whom angioplasty had been attempted with an in-hospital mortality and infarction rate of 2.5% and 4.8%, respectively. Emergency coronary bypass surgery was needed in 4.9%. Of the 867 patients, 41% (group 1) were considered to have complete revascularization and 59% (group 2) to have incomplete revascularization. Univariate analysis revealed major differences between these two groups with patients in group 2 characterized by advanced age, more severe angina, a greater likelihood of previous coronary surgery and infarction, more extensive disease and poorer left ventricular function. Over a mean follow-up period of 26 months, the probability of event-free survival was significantly lower for group 2 only with respect to the need for coronary artery surgery (p = 0.004) and occurrence of severe angina (p = 0.04). The difference in mortality was of borderline significance (p = 0.051) and there were no significant differences between groups 1 and 2 in either the incidence of myocardial infarction or the need for repeat angioplasty. Multivariate analysis identified independent baseline predictors of late cardiac events that were then used to adjust the probabilities of event-free survival. This adjustment effectively removed any significant influence of completeness of revascularization on event-free survival for any of the above end points including the combination of death, myocardial infarction and need for coronary artery surgery. Therefore, late outcome in these patients is not significantly influenced by revascularization status but depends more on baseline patient characteristics.

Age Factors↗

PubMedDate not supplied

[Interventional treatment of lesions of unprotected left main coronary disease].

The percutaneous treatment of unprotected left main coronary artery disease began with the first angioplasties, but was discarded soon because of its high mortality. With the new techniques of percutaneous interventions, the more frequent use of the stent and antithrombotic medication, acute angiographic alterations can be treated with success in most patients. Hospital mortality is related to the baseline status, being worse for patients with acute myocardial infarction or at high surgical risk. The restenosis rate is related to the location of the lesion and the reference size of the vessel. Nowadays, the percutaneous treatment for the unprotected left main coronary artery disease is no longer an absolute contraindication for certain patients, although there is still not enough scientific evidence for its use as standard treatment for all of them.

Coronary Disease↗

PubMed1990