8 results on '"Yinggan Zheng"'
Search Results
2. Comparison of Angiotensin‐Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Management Strategies Before Cardiac Surgery: A Pilot Randomized Controlled Registry Trial
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Sean van Diepen, Colleen M. Norris, Yinggan Zheng, Jayan Nagendran, Michelle M. Graham, Damaris Gaete Ortega, Derek R. Townsend, Justin A. Ezekowitz, and Sean M. Bagshaw
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angiotensin‐converting enzyme inhibitor ,angiotensin receptor blocker ,cardiac surgery ,vasoplegia ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Postoperative clinical outcomes associated with the preoperative continuation or discontinuation of angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) before cardiac surgery remain unclear. Methods and Results In a single‐center, open‐label, randomized, registry‐based clinical trial, patients undergoing nonemergent cardiac surgery were assigned to ACEI/ARB continuation or discontinuation 2 days before surgery. Among the 584 patients screened, 261 met study criteria and 126 (48.3%) patients were enrolled. In total,121 patients (96% adherence; 60 to continuation and 61 to ACEI/ARB discontinuation) underwent surgery and completed the study protocol, and follow‐up was 100% complete. Postoperative intravenous vasopressor use (78.3% versus 75.4%, P=0.703), vasodilator use (71.7% versus 80.3%, P=0.265), vasoplegic shock (31.7% versus 27.9%, P=0.648), median duration of vasopressor (10 versus 5 hours, P=0.494), and vasodilator requirements (10 versus 9 hours, P=0.469) were not significantly different between the continuation and discontinuation arms. No differences were observed in the incidence of acute kidney injury (1.7% versus 1.6%, P=0.991), stroke (no events, mortality (1.7% versus 1.6%, P=0.991), median duration of mechanical ventilation (6 versus 6 hours, P=0.680), and median intensive care unit length of stay (43 versus 27 hours, P=0.420) between the treatment arms. Conclusions A randomized study evaluating the routine continuation or discontinuation of ACEIs or ARBs before cardiac surgery was feasible, and treatment assignment was not associated with differences in postoperative physiological or clinical outcomes. These preliminary findings suggest that preoperative ACEI/ARB management strategies did not affect the postoperative course of patients undergoing cardiac surgery. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02096406.
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- 2018
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3. Relationship Between Arterial Access and Outcomes in ST‐Elevation Myocardial Infarction With a Pharmacoinvasive Versus Primary Percutaneous Coronary Intervention Strategy: Insights From the STrategic Reperfusion Early After Myocardial Infarction (STREAM) Study
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Jay Shavadia, Robert Welsh, Anthony Gershlick, Yinggan Zheng, Kurt Huber, Sigrun Halvorsen, Phillipe G. Steg, Frans Van de Werf, and Paul W. Armstrong
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arterial access ,pharmacoinvasive strategy ,primary percutaneous coronary intervention ,ST‐segment elevation myocardial infarction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundThe effectiveness of radial access (RA) in ST‐elevation myocardial infarction (STEMI) has been predominantly established in primary percutaneous coronary intervention (pPCI) with limited exploration of this issue in the early postfibrinolytic patient. The purpose of this study was to compare the effectiveness and safety of RA versus femoral (FA) access in STEMI undergoing either a pharmacoinvasive (PI) strategy or pPCI. Methods and ResultsWithin STrategic Reperfusion Early After Myocardial Infarction (STREAM), we evaluated the relationship between arterial access site and primary outcome (30‐day composite of death, shock, congestive heart failure, or reinfarction) and major bleeding according to the treatment strategy received. A total of 1820 STEMI patients were included: 895 PI (49.2%; rescue PCI [n=379; 42.3%], scheduled PCI [n=516; 57.7%]) and 925 pPCI (50.8%). Irrespective of treatment strategy, there was comparable utilization of either access site (FA: PI 53.4% and pPCI 57.6%). FA STEMI patients were younger, had lower presenting systolic blood pressure, lesser Thrombolysis In Myocardial Infarction risk, and more ∑ST‐elevation at baseline. The primary composite endpoint occurred in 8.9% RA versus 15.7% FA patients (P
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- 2016
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4. Providing Rapid Out of Hospital Acute Cardiovascular Treatment 4 (PROACT‐4)
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Justin A. Ezekowitz, Robert C. Welsh, Dale Weiss, Michael Chan, William Keeble, Fadi Khadour, Sanjay Sharma, Wayne Tymchak, Sunil Sookram, Neil Brass, Darren Knapp, Thomas L. Koshy, Yinggan Zheng, and Paul W. Armstrong
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acute coronary syndromes ,ambulance ,chest pain ,clinical trial ,troponin ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Whether prehospital point‐of‐care (POC) troponin further accelerates the time to diagnosis in patients with chest pain (CP) is unknown. We conducted a randomized trial of POC‐Troponin testing in the ambulance. Methods and Results Patients with chest pain presenting by ambulance were randomized to usual care (UC) or POC‐Troponin; ST‐elevation myocardial infarction patients or those with noncardiovascular symptoms were excluded. Pre‐hospital high‐sensitivity troponin was analyzed on a POC device and available to the paramedic and emergency department (ED) staff. The final diagnosis was centrally adjudicated. The primary endpoint was time from first medical contact to discharge from ED or admission to hospital. We randomized 601 patients in 19 months; 296 to UC and 305 to POC‐Troponin. After ambulance arrival, the first troponin was available in 38 minutes in POC‐Troponin and 139 minutes in UC. In POC‐Troponin, the troponin was >0.01 ng/mL in 17.4% and >0.03 ng/mL in 9.8%. Patients spent a median of 9.0 hours from first medical contact to final disposition, and 165 (27.4%) were admitted to the hospital. The primary endpoint was shorter in patients randomized to POC‐Troponin (median 8.8 hours [6.2–10.8] compared to UC (median 9.1 hours [6.7–11.2]; P=0.05). There was no difference in the secondary endpoint of repeat ED visits, hospitalizations, or death in the next 30 days. Conclusions In this broad population of patients with CP, ambulance POC‐Troponin accelerated the time to final disposition. Enhanced and more cost‐effective early ED discharge of the majority of patients with CP calling 911 is an unrealized opportunity. Clinical Trial Registration URL: https://www.ClinicalTrials.gov/. Unique identifier: NCT01634425.
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- 2015
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5. Ticagrelor or clopidogrel dual antiplatelet therapy following a pharmacoinvasive strategy in <scp>ST</scp> ‐segment elevation myocardial infarction
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Kevin R. Bainey, Robert C. Welsh, Benjamin Tyrrell, Yinggan Zheng, R. Leung, and Jay Shavadia
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Ticagrelor ,medicine.medical_specialty ,medicine.medical_treatment ,Clinical Investigations ,STEMI ,Percutaneous Coronary Intervention ,P2Y12 ,Internal medicine ,Fibrinolysis ,medicine ,Humans ,ST segment ,antiplatelets ,Prospective Studies ,cardiovascular diseases ,Myocardial infarction ,Stroke ,pharmacoinvasive reperfusion ,Drug Substitution ,business.industry ,General Medicine ,medicine.disease ,Clopidogrel ,Treatment Outcome ,Conventional PCI ,Cardiology ,ST Elevation Myocardial Infarction ,fibrinolysis ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Objectives To describe and evaluate outcomes in STEMI patients sustained on clopidogrel compared to those switched to ticagrelor following fibrinolysis. Background World‐wide, many STEMI patients cannot achieve timely PCI and therefore require fibrinolysis. Although comparable 30‐day and 1‐year safety was shown with clopidogrel or ticagrelor in the TREAT study, there is paucity of long‐term outcomes in pharmacoinvasive treated STEMI. Methods We conducted an observational cohort study evaluating consecutive pharmacoinvasive STEMI patients treated in a network, comparing those switched to ticagrelor to those sustained on clopidogrel. The primary efficacy composite was one‐year all‐cause death, recurrent myocardial infarction, and stroke with major bleeding and intracranial hemorrhage (ICH) as the safety outcomes. Multivariable Cox regression model was used to examine the association between P2Y12 inhibitor and outcomes with inverse probability weighting. Results Of 1426 pharmacoinvasive STEMI patients, 28% (n = 396) were converted to ticagrelor at a mean of 9.9 h after fibrinolysis with comparable GRACE Risk Scores (median; 158 vs 157, p0.352). The primary composite occurred in 3.5% of ticagrelor and 7.0% of clopidogrel treated patients (p0.014). Following adjustment, ticagrelor was associated with a 54% lower composite outcome (adjusted HR 0.46, 95% confidence interval 0.26–0.84). Major bleeding 6.3% vs 6.1% (NS) and ICH 0.0% vs 0.2% (NS) were similar. Conclusions In a prospective STEMI cohort, switching to ticagrelor compared with sustaining clopidogrel following fibrinolysis pharmacoinvasive reperfusion reduced recurrent ischemic events at 1‐year with no differences in major bleeding or ICH. Aligned with randomized data, these findings provide support to switch pharmaco‐invasively treated STEMI patients.
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- 2021
6. Association between glycated haemoglobin levels and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease: a secondary analysis of the <scp>TECOS</scp> randomized clinical trial
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Yinggan Zheng, Finlay A. McAlister, Jennifer B. Green, John B. Buse, Cynthia M. Westerhout, Darren K. McGuire, Paul W. Armstrong, Rury R. Holman, Frans Van de Werf, and Eberhard Standl
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Male ,medicine.medical_specialty ,Type 2 diabetes ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Interquartile range ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,Hypoglycemic Agents ,Myocardial infarction ,Stroke ,Aged ,Randomized Controlled Trials as Topic ,Glycated Hemoglobin ,Heart Failure ,Unstable angina ,business.industry ,Sitagliptin Phosphate ,Hazard ratio ,medicine.disease ,Hospitalization ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aims Whether glycaemic control is associated with cardiovascular outcomes in patients with type 2 diabetes (T2D) is unclear. Consequently, we assessed the relationship between glycated haemoglobin (HbA1c ) and cardiovascular outcomes in a placebo-controlled randomized trial which demonstrated no cardiovascular effect of sitagliptin in patients with T2D and atherosclerotic vascular disease. Methods and results Secondary analysis of 14 656 TECOS participants with time to event analyses using multivariable Cox proportional hazard models. During a median 3.0 (interquartile range 2.3-3.8) year follow-up, 456 (3.1% of 14 656) patients had first hospitalization for heart failure (HF), 1084 (11.5%) died, 1406 (9.6%) died or were hospitalized for HF, and 1689 (11.5%) had a non-HF cardiovascular event (cardiovascular death, non-fatal stroke, non-fatal myocardial infarction, or hospitalization for unstable angina). Associations between baseline or time-varying HbA1c and cardiovascular outcomes were U-shaped, with the lowest risk when HbA1c was around 7%. Each one-unit increase in the time-varying HbA1c above 7% was associated with an adjusted hazard ratio (HR) of 1.21 [95% confidence interval (CI) 1.11-1.33] for first HF hospitalization, 1.11 (1.03-1.21) for all-cause death, 1.18 (1.09-1.26) for death or HF hospitalization, and 1.10 (1.02-1.17) for non-HF cardiovascular events. Each one-unit decrease in the time-varying HbA1c below 7% was associated with an adjusted HR of 1.35 (95% CI 1.12-1.64) for first HF hospitalization, 1.37 (1.16-1.61) for death, 1.42 (1.23-1.64) for death or HF hospitalization, and 1.22 (1.06-1.41) for non-HF cardiovascular events. Conclusion Glycated haemogobin exhibits a U-shaped association with cardiovascular outcomes in patients with T2D and atherosclerotic vascular disease, with nadir around 7%. Clinical trial registration ClinicalTrials.gov Identifier: NCT00790205.
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- 2020
7. Sitagliptin and risk of fractures in type 2 diabetes: Results from the TECOS trial
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Tsvetalina Tankova, Yinggan Zheng, Helena W. Rodbard, John B. Buse, Keith D. Kaufman, Robert G. Josse, Eric D. Peterson, M. Angelyn Bethel, Cynthia M. Westerhout, Rury R. Holman, Amanda I Adler, Sumit R. Majumdar, Jennifer B. Green, and Paul W. Armstrong
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medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,Hazard ratio ,030209 endocrinology & metabolism ,Type 2 diabetes ,030204 cardiovascular system & hematology ,medicine.disease ,Placebo ,Lower risk ,Confidence interval ,Surgery ,Metformin ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Diabetes mellitus ,Internal medicine ,Sitagliptin ,Internal Medicine ,medicine ,business ,medicine.drug - Abstract
Aim To examine fracture incidence among participants in the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS). Research design and methods We used data from 14 671 participants in the TECOS study who were randomized double-blind to sitagliptin (n = 7332) or placebo (n = 7339). Cumulative fracture incidence rates were calculated and their association with study treatment assignment was examined using multivariable Cox proportional hazards regression. Results The baseline mean (standard deviation) participant age was 65.5 (8.0) years, diabetes duration was 11.6 (8.1) years and glycated haemoglobin level was 7.2 (0.5)% [55.2 (5.5) mmol/mol], and 29.3% of participants were women and 32.1% were non-white. During 43 222 person-years’ follow-up, 375 (2.6%; 8.7 per 1000 person-years) had a fracture; 146 were major osteoporotic fractures (hip, n = 34; upper extremity, n = 81; and clinical spine, n = 31). Adjusted analyses showed fracture risk increased independently with older age (P < .001), female sex (P < .001), white race (P < .001), lower diastolic blood pressure (P < .001) and diabetic neuropathy (P = .003). Sitagliptin, compared with placebo, was not associated with a higher fracture risk [189 vs 186 incident fractures: unadjusted hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.82 to 1.23, P = .944; adjusted HR 1.03, P = .745], major osteoporotic fractures (P = .673) or hip fractures (P = .761). Insulin therapy was associated with a higher fracture risk (HR 1.40, 95% CI 1.02-1.91; P = .035), and metformin with a lower risk (HR 0.76, 95% CI 0.59-0.98; P = .035). Conclusion Fractures were common among people with diabetes in the TECOS study, but were not related to sitagliptin therapy. Insulin and metformin treatment were associated with higher and lower fracture risks, respectively.
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- 2016
8. Using the Attribute Hierarchy Method to Identify and Interpret Cognitive Skills that Produce Group Differences
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Yinggan Zheng, Ying Cui, and Mark J. Gierl
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Cognitive model ,Test design ,business.industry ,computer.software_genre ,Education ,Test (assessment) ,Task (project management) ,Pattern recognition (psychology) ,Developmental and Educational Psychology ,Psychology (miscellaneous) ,Artificial intelligence ,Cognitive skill ,Data mining ,Attribute hierarchy method ,business ,Set (psychology) ,Psychology ,computer ,Applied Psychology ,Natural language processing - Abstract
The purpose of this study is to describe how the attribute hierarchy method (AHM) can be used to evaluate differential group performance at the cognitive attribute level. The AHM is a psychometric method for classifying examinees’ test item responses into a set of attribute-mastery patterns associated with different components in a cognitive model of task performance. Attribute probabilities, computed using a neural network, can be estimated on each attribute for each examinee thereby providing specific information about the examinee’s attribute-mastery level. These probabilities can also be compared across groups. We describe a four-step procedure for estimating and interpreting group differences using the AHM. We also provide an example using student response data from a sample of algebra items on the SAT to illustrate our pattern recognition approach for studying group differences. Assessment engineering (AE) is emerging as a new research area in educational and psychological measurement (Luecht, 2006a, 2006b). AE is an innovative approach to measurement, where engineering-like principles are used to direct the design and the analysis of assessments as well as the scoring and the reporting of the results. With this approach, an assessment begins with specific, empirically derived cognitive models (e.g., Leighton & Gierl, 2007). Next, assessment task templates are created using established frameworks derived from the cognitive model to produce test items. Finally, psychometric methods are applied to the examinee response data, typically in a confirmatory mode, to produce scores that are interpretable (Luecht, Gierl, Tan, & Huff, 2006). AE differs from more traditional approaches to test design and analysis in three fundamental ways. First, cognitive models guide task design and item development, rather than content-based test specifications. While the categories in content blueprints can be included in the task templates, the assessment principles used to develop items are based on cognitive principles and, thus, provide more specific information for measuring problem-solving skills. Second, task templates are created to control and manipulate both the content and cognitive attributes of the items. Item writers are required to use the templates during development, thereby producing items that adhere to strict quality controls and that meet high psychometric standards. Third, psychometric models are employed in a confirmatory, versus exploratory, manner to assess the model-data fit relative to the intended underlying structure of the constructs or traits the test is designed to measure. The outcomes from these model-data fit analyses also provide developers with guidelines for
- Published
- 2008
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