To evaluate the outcome of coronary artery bypass grafting (CABG) for failed percutaneous coronary intervention (PCI) in patients who had received abciximab.
In this retrospective study, we analyzed ...the records of patients who had PCI at our institution between January 1994 and December 1998 and identified those who had urgent or emergency CABG within 48 hours after PCI. CABG was performed for failed PCI in patients who had ongoing ischemia, hemodynamic compromise, or both. These patients were categorized into 2 groups depending on whether they had been given abciximab during PCI. We compared blood product transfusion requirements, bleeding complications, and frequency of in-hospital adverse events of the 2 groups.
Of 5636 patients who had PCI, 77 (1.4%) had urgent or emergency CABG within 48 hours, including 11 who were given abciximab (abciximab group) during PCI and 66 who were not given abciximab (no abciximab group). The 2 groups had similar baseline characteristics. The mean ± SD time to surgery was 8.4±8.0 hours (median, 6 hours) for the abciximab group vs 12.1±12.5 hours (median, 4 hours) for the no abciximab group. Major bleeding (Thrombolysis in Myocardial Infarction criteria) occurred in 9 (90%) of 10 patients in the abciximab group vs 48 (77%) of 62 patients in the no abciximab group. The total volumes of intraoperative autotransfusion and transfusion of red blood cells and fresh frozen plasma tended to be higher for the abciximab group. Also, this group received a mean of 13.9 U of platelets vs 3.2 U for the no abciximab group (P<.001). However, no in-hospital deaths occurred among patients in the abciximab group, and adverse events were infrequent and comparable between the 2 groups. No difference was noted between the 2 groups in the frequency of surgical reexploration for bleeding.
Transfusion requirements are higher for patients who undergo emergency or urgent CABG after having received abciximab during PCI. However, in-hospital adverse events are infrequent and comparable to those for patients who do not receive abciximab.
Significant limitations are associated with the use of standard radiographic measurements as indicators of response in glioma therapy trials. The Response Evaluation Criteria in Solid Tumors (RECIST) ...were recently introduced in an attempt to standardize and simplify assessment of response to treatment in cancer clinical trials. However, their applicability in gliomas has been assessed in only a very small number of patients. Our aim was to validate radiographic response assessment in newly diagnosed glioma patients. Sixty-seven newly diagnosed glioma patients participating in nine North Central Cancer Treatment Group glioma trials were included; 565 MRI scans were analyzed. All scans were performed with the same technique. Kappa statistics were calculated to determine agreement between assessment methods. Cox proportional hazards analyses and time-dependent Cox models were used to assess the association between different measurement methods and overall survival. Results showed agreement between the one-dimensional (1D) and two-dimensional (2D) measurements both for T2 images and for gadolinium-enhanced images. Comparison of duration of response and time to progression as assessed by eight different methods showed similarity in response assessments by 1D, 2D, area, and volume gadolinium measurements. In contrast, time to progression was significantly shorter when assessed by 1D–T2 or 2D–T2 images as compared to area–T2 or volume–T2 images. This set of data indicates that RECIST could be used instead of 2D imaging for response assessment in newly diagnosed glioma trials. Overall, responses as determined by any tumor measurement method did not correlate with patient survival for either enhancing or nonenhancing tumors, although the small number of responders limits definitive conclusions. Time-dependent Cox models demonstrated that, in contrast to the case of nonenhancing tumors, progression as determined by 1D, 2D, area, and volume measurements in gadolinium-enhanced images was predictive of survival of patients with enhancing tumors.
Introduction: Upper limit of vulnerability (ULV) has a strong correlation with defibrillation threshold (DFT) in patients with implantable cardioverter defibrillators (ICDs). Significant ...discrepancies between ULV and DFT are infrequent. The aim of this study was to characterize patients with such discrepancies.
Methods and Results: The ULV and DFT were determined in 167 ICD patients. Univariate and multivariate analyses were used to evaluate clinical predictors of a significant difference (≥10 J) between ULV and DFT. Only 8 patients (5%) had ≥10 J difference. ULV exceeded DFT in all of them. Absence of coronary artery disease (6/8 vs 48/159 patients; P = 0.05) and absence of documented ventricular arrhythmias (4/8 vs 12/159 patients; P = 0.01) were the only independent predictors of a significant ULV‐DFT discrepancy.
Conclusion: Significant discrepancies between ULV and DFT occur in 5% of patients with ICDs. Absence of coronary disease and documented ventricular arrhythmias predict such a discrepancy. At ICD implant, DFT testing is recommended in these patients and in patients with a high (>20 J) ULV before first‐shock energy and the need for lead repositioning are determined. (J Cardiovasc Electrophysiol, Vol. 14, pp. 728‐732, July 2003)
Thesis (Ph. D.)--Massachusetts Institute of Technology, Sloan School of Management, 1991.
Includes bibliographical references (leaves 268-285).
by Karla V. Ballman.
Ph.D.
Discrete Choice Methods With Simulations Ballman, Karla V
Journal of the American Statistical Association,
20/3/1/, Letnik:
100, Številka:
469
Book Review, Journal Article
Recenzirano
Ballman reviews Discrete Choice Methods With Simulations by Kenneth E. Train.
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