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At least 1,045 records · Page 58Linked to original sources
PubMed1988

Short-term risk stratification at admission based on simple clinical data in acute myocardial infarction.

Simple clinical data, available in all coronary care units, were recorded in 1,013 consecutive patients with acute myocardial infarction (AMI). In order to identify the patients at highest and lowest risk of mortality during hospital stay, a prognostic index was established from a stepwise logistic discriminant analysis of 10 clinical variables obtained at admission in a consecutive series of 477 patients hospitalized in 1 of 2 coronary care units admitting new patients on alternate days and treating them similarly. This prognostic index was applied to a comparison group of 536 consecutive patients admitted to the other coronary care unit. In the experimental group, 57 of the 477 patients (12%) died during hospital stay; 60 of the 536 patients (11%) died in the comparison group. As individual variables, age, previous history of AMI, anterior site and left ventricular function on admission were associated with increased mortality. Three variables were selected from the stepwise logistic discriminant analysis of the experimental group: age; site (anterior = 1, other = 0); and grade of left ventricular function (0 to 4). Prognostic index = 5.9019 - 0.8961 function - 0.5708 location - 0.0369 age. This index was validated in the comparison group. Patients were allocated into different classes with increasing index values associated with decreasing risk. Three subgroups of patients were identified: high risk of hospital mortality (index less than or equal to 1; mortality: 51%), intermediate risk (index 1 to 3; mortality: 18%) and low risk (index greater than 3; mortality: 4%). The use of this simple prognostic index may improve clinical management and selection of patients for intervention trials.

Female↗
PubMed1988

Use of exercise thallium-201 imaging for risk stratification of elderly patients with coronary artery disease.

Although coronary artery disease (CAD) may be asymptomatic, it is the most common cause of death in elderly patients in the U.S. This study examined the prognosis of 449 patients with a mean age of 65 years using exercise thallium-201 imaging. At a follow-up of 25 months, 45 patients underwent coronary artery revascularization, 8 died of cardiac causes and 10 had nonfatal acute myocardial infarctions (AMIs). Thus the total of patients with "hard" events was 18. The events included 12 of 276 patients with atypical or non-anginal symptoms versus 6 of 128 with typical angina (p = not significant); 7 of 51 patients (14%) with Q-wave AMI versus 11 of 353 (3%) without Q-wave AMI (p less than 0.001); 1 of 183 patients (1%) with normal versus 17 of 221 (8%) with abnormal exercise thallium-201 images (p less than 0.002); 10 of 76 patients (13%) with multi vessel thallium-201 abnormality vs 8 of 328 (2%) with no or 1-vessel thallium-201 abnormality (p less than 0.001) and 10 of 96 patients (10%) with greater than or equal to 3 abnormal segments by thallium-201 imaging (total segments = 9) versus 8 of 308 patients with no or less than 3 abnormal segments (p less than 0.001). The number of segments with thallium-201 defects was 1 +/- 2 patients without and 3 +/- 2 in patients with hard events (p less than 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1990

Antithrombotic therapy in cardiac disease: an approach based on pathogenesis and risk stratification.

An approach to the management of thrombosis and embolism in various cardiovascular disorders is discussed. This approach is based on current knowledge of pathogenesis and risk of thromboembolism. Rational therapeutic guidelines are formulated along the lines of anatomic location (arterial circulation, cardiac chambers or prosthetic valves), pathophysiology (activation of platelets or the coagulation system, or both), and degree of thromboembolic risk. With clear understanding of these factors, it may be possible to determine the most suitable platelet inhibitor or anticoagulant regimen for the individual patient, and whether these agents should be given singly or in combination.

Anticoagulants↗
PubMed1990

Risk stratification of left ventricular hypertrophy in systemic hypertension using noninvasive ambulatory blood pressure monitoring.

Twenty-four-hour noninvasive ambulatory blood pressure (BP) monitoring and echocardiography were performed in 165 consecutive untreated hypertensive patients and in 92 healthy subjects. In the hypertensive group, left ventricular (LV) mass index showed closer correlations (all p less than 0.01 in the comparisons between the r coefficients) with average 24-hour ambulatory systolic (r = 0.47) and diastolic (r = 0.33) BP than with casual systolic (r = 0.35) and diastolic (r = 0.28) BP. Hypertensive patients were classified according to the difference between their observed and predicted levels of ambulatory BP (the latter assessed by regressing the observed ambulatory BP on the casual BP). When compared to those with lower than predicted ambulatory BP (less than or equal to 10 mm Hg systolic, less than or equal to 6 mm Hg diastolic), patients with higher than predicted ambulatory BP (greater than or equal to 10 mm Hg systolic and greater than or equal to 6mm Hg diastolic) had higher values of LV mass index and other indexes of LV hypertrophy (all p less than 0.01) but had similar values of casual BP. Prevalence of LV hypertrophy was 6 to 10% in the former and 35 to 39% in the latter (p less than 0.001). None of the indexes of LV structure differed between the group with low ambulatory BP and the normotensive group. It is concluded that hypertensive patients whose ambulatory BP readings are notably higher than one would predict from clinical BP readings are at highest risk of LV hypertrophy, an independent prognostic marker.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1993

Stratification of sudden death risk in patients receiving long-term amiodarone treatment for sustained ventricular tachycardia or ventricular fibrillation.

One hundred twenty-two patients treated chronically with amiodarone for sustained ventricular tachycardia or ventricular fibrillation after failing conventional antiarrhythmic therapy were analyzed to determine which factors were predictive of sudden cardiac death during follow-up. The mean left ventricular ejection fraction in the study group was 0.32, and 87% of the patients had coronary artery disease with a prior myocardial infarction. During a median follow-up of 19.5 months, 30 patients died suddenly. The only variable that was predictive of sudden death was left ventricular ejection fraction. Twenty-nine of the 84 patients with ejection fractions < 0.40 died suddenly, compared with 1 of 35 patients with ejection fractions > or = 0.40. The actuarial probability of sudden death at 5 years was 49% when the ejection fraction was < 0.40, and 5% when the ejection fraction was > or = 0.40 (p = 0.0004). These results indicate that patients treated with amiodarone for sustained ventricular tachycardia or ventricular fibrillation whose ejection fractions are > or = 0.40 are at low risk for sudden death. Patients with ejection fractions < 0.40 remain at high risk for sudden death, and should be considered for additional or alternative therapy.

Actuarial Analysis↗
PubMed1993

Radionuclide angiography for risk stratification of patients with coronary artery disease.

Radionuclide angiography has become an accepted diagnostic method that is relied upon for its rapid, accurate and quantitative capabilities to characterize LV function. This method will continue to be used extensively in the future for the evaluation of patients with CAD. In addition to its common use to measure LV function at rest, the application of radionuclide angiography to assess LV function during exercise has proven prognostic potential that can be used in the clinical decision-making process in patients with known or suspected CAD.

Coronary Disease↗
PubMed1991

Stratification and standards: a quality assurance perspective. Presidential address.

A diminished public respect for physicians, a decrease in professional autonomy, and an increased regulatory presence have led to extensive changes in medical practice in the past 25 years. Along with rising costs of medical care, there has been a resurgence in interest in the quality of health care, and a considerable body of literature on the monitoring and evaluation of health services has been produced. Quality assurance programs frequently evoke negative and skeptical responses from many physicians for a variety of reasons. Crucial to the potential effectiveness of quality assessment methods is the setting of standards. Physician clinicians should be strongly encouraged to participate directly and seriously in the development of standards. The quality assurance process should be viewed by physicians as an opportunity to recapture the control of the profession and to demonstrate to patients, in an objective manner, the legitimate high quality of care rendered.

Humans↗
PubMed1994

Risk stratification in patients bridged to cardiac transplantation.

Patient selection is considered one of the most important factors influencing success in bridge to transplant procedures. However, to date it has been difficult to identify predictors of mortality in this population using univariate or multivariate analysis. In 1988, we developed a scoring system using 21 clinical variables that could be calculated rapidly at the bedside while evaluating potential candidates. Points were designated to these variables using a scale of 1 to 3, 1 having the least adverse effect on survival and 3 the most. Patients received a value of 0 for each variable that did not apply. This scoring system was used in a retrospective analysis for 15 bridge to transplant patients. The results showed a significant difference (p < 0.003) between the 8 survivors (mean score, 5.75 +/- 2.19) and the 7 nonsurvivors (mean score, 11.71 +/- 3.45). Since 1989, we have prospectively calculated the scores in an additional 27 patients. Based on the score, all 42 patients were divided into three groups: group I had scores of 1 to 5; group II, 6 to 10; and group III, 11 to 16. The mean score for group I (16 patients) was 3.69 +/- 1.25. All group I patients survived. Group II patients (n = 15) had a mean score of 7.87 +/- 1.36 and a survival rate of 53%. The mean score for group III (n = 11) was 13 +/- 1.73. Thirty-six percent of these patients survived. Comparison of survival and mean scores among the three groups was statistically significant (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗