72 results on '"Yinggan Zheng"'
Search Results
52. REAL WORLD RELATIONSHIPS BETWEEN BASELINE Q WAVES, TIME FROM SYMPTOM ONSET AND CLINICAL OUTCOMES IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION PATIENTS: INSIGHT FROM THE VITAL HEART RESPONSE REGISTRY
- Author
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Robert C. Welsh, Kevin R. Bainey, Ben Tyrrell, Paul W. Armstrong, Yinggan Zheng, and Neil Brass
- Subjects
medicine.medical_specialty ,business.industry ,medicine.disease ,Clinical trial ,surgical procedures, operative ,Internal medicine ,Cardiology ,Medicine ,ST segment ,cardiovascular diseases ,Symptom onset ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Baseline (configuration management) - Abstract
Background: Baseline Q waves on the initial 12-lead ECG in clinical trials has been shown to be a simple predictor of clinical outcomes in STEMI patients. Whether this relationship applies in real world STEMI care is unknown. Using a large comprehensive STEMI registry, we evaluated the relationships
- Published
- 2017
53. Corrigendum to 'Reduced dose tenecteplase and outcomes in elderly ST-segment elevation myocardial infarction patients: Insights from the Strategic Reperfusion Early After Myocardial infarction trial' [Am Heart J 169/6 (2015) 890–898]
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Erich Bluhmki, Paul W. Armstrong, Yves Lambert, Cynthia M. Westerhout, Yinggan Zheng, Fernado Rosell-Ortiz, Thierry Danays, Peter Sinnaeve, Renato D. Lopes, and Frans Van de Werf
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Tenecteplase ,ST segment ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,Reduced dose ,medicine.disease ,medicine.drug - Published
- 2017
54. Applying novel methods to assess clinical outcomes: insights from the TRILOGY ACS trial
- Author
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Shaun G. Goodman, Eileen Brown, Matthew T. Roe, Cynthia M. Westerhout, Judith S. Hochman, E. Magnus Ohman, Paul W. Armstrong, Yuliya Lokhnygina, Yinggan Zheng, Jeffrey A. Bakal, and Keith A.A. Fox
- Subjects
medicine.medical_specialty ,Acute coronary syndrome ,Prasugrel ,Ticlopidine ,Endpoint Determination ,Myocardial Infarction ,Recurrence ,Internal medicine ,medicine ,Humans ,Clinical significance ,Angina, Unstable ,Aged ,Surrogate endpoint ,business.industry ,Hazard ratio ,Middle Aged ,Clopidogrel ,medicine.disease ,Coronary revascularization ,Survival Analysis ,Surgery ,Clinical trial ,Stroke ,Treatment Outcome ,Purinergic P2Y Receptor Antagonists ,Cardiology and Cardiovascular Medicine ,business ,Prasugrel Hydrochloride ,Platelet Aggregation Inhibitors ,medicine.drug - Abstract
Aims Several methods provide new insights into understanding clinical trial composite endpoints, using both conventional and novel methods. The TRILOGY ACS trial is used as a contemporary example to prospectively compare these methods side by side. Methods and results The traditional time-to-first-event, Andersen–Gill recurrent events method, win ratio, and a weighted composite endpoint (WCE) are compared using the randomized, active-control TRILOGY ACS trial. This trial had a neutral result and randomized 9326 patients managed without coronary revascularization within 10 days of their acute coronary syndrome to receive either prasugrel or clopidogrel and followed them for up to 30 months. The traditional composite, win ratio, and WCE demonstrated no significant survival advantage for prasugrel, whereas the Andersen–Gill method demonstrated a statistical advantage for prasugrel [hazard ratio (HR), 0.86 (95% CI, 0.72–0.97)]. The traditional composite used 73% of total patient events; 40% of these were derived from the death events. The win ratio used 66% of total events; deaths comprised 57% of these. Both Andersen–Gill and WCE methods used all events in all participants; however, with the Andersen–Gill method, death comprised 41% of the proportion of events, whereas with the WCE method, death comprised 64% of events. Conclusion This study addresses the relative efficiency of various methods for assessing clinical trial events comprising the composite endpoint. The methods accounting for all events, in particular those incorporating their clinical relevance, appear most advantageous, and may be useful in interpreting future trials. This clinical and statistical advantage is especially evident with long-term follow-up where multiple non-fatal events are more common. Clinical Trial Registration NCT00699998.
- Published
- 2014
55. Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial
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Cynthia M. Westerhout, Yves Lambert, Vitaly A. Sulimov, Frans Van de Werf, Fernando Rosell-Ortiz, Patrick Goldstein, Anthony H. Gershlick, Paul W. Armstrong, Neda Dianati Maleki, Yinggan Zheng, and Jennifer Adgey
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Time-to-Treatment ,Electrocardiography ,Percutaneous Coronary Intervention ,Fibrinolytic Agents ,Internal medicine ,Early Medical Intervention ,Pexelizumab ,Fibrinolysis ,Medicine ,Creatine Kinase, MB Form ,Humans ,cardiovascular diseases ,Myocardial infarction ,Aged ,Interventional cardiology ,business.industry ,Percutaneous coronary intervention ,Cardiovascular Agents ,Middle Aged ,medicine.disease ,Troponin ,Treatment Outcome ,Cardiovascular agent ,Conventional PCI ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Fibrinolytic agent ,Biomarkers ,medicine.drug - Abstract
We evaluated the prespecified endpoint, aborted myocardial infarction (AbMI), according to the use of a pharmacoinvasive (PI) strategy versus primary percutaneous coronary intervention (PCI) in 1754 patients randomised within 3 h of symptom onset in the STrategic Reperfusion Early After Myocardial infarction (STREAM) trial.Based on sequential ECG's and biomarkers, AbMI was defined as ST-elevation resolution ≥50% (90 min posttenecteplase (TNK) in the PI arm or 30 min postprimary PCI) with minimal biomarker rise.In the PI arm 11.1% (n=99) had AbMI versus 6.9% (n=59) in primary PCI arm (p0.01). In a multivariable model, AbMI patients overall had less baseline ΣST-deviation, fewer baseline Q-waves and shorter total ischaemic times. PI AbMI patients had faster time to TNK (90 vs 100 min, p=0.015): total ischaemic time was 100 min longer in primary PCI AbMI patients and no difference in ischaemic time existed between AbMI and non-AbMI patients within this group. Although no significant interaction between treatment and AbMI on the composite endpoint of death/shock/congestive heart failure/recurrent MI occurred (p=0.292), PI AbMI patients had a lower incidence in this endpoint than non-AbMI patients (5.1 vs 12%, p=0.038); this was not evident in primary PCI patients. Forty-five patients (ie, 2.5%) had masquerading MI with minimal biomarker elevation and no evolution in baseline ST-elevation.A PI strategy of early fibrinolysis more frequently aborts MI than primary PCI. Such PI patients had more favourable outcomes as compared with non-AbMIs. Diligent review of ECG evolution in STEMI distinguishes AbMI from infarct masquerade. ClinicalTrials.gov ID: NCT00623623.
- Published
- 2014
56. Prognostic implications of quantitative evaluation of baseline Q-wave width in ST-segment elevation myocardial infarction
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Galen S. Wagner, Yinggan Zheng, Mike Bao, Paul W. Armstrong, Christopher B. Granger, Yuling Fu, Cynthia M. Westerhout, and Bernard R. Chaitman
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Male ,medicine.medical_specialty ,Internationality ,medicine.medical_treatment ,Myocardial Infarction ,Shock, Cardiogenic ,Comorbidity ,Antibodies, Monoclonal, Humanized ,Sensitivity and Specificity ,Electrocardiography ,Double-Blind Method ,Internal medicine ,medicine ,ST segment ,Humans ,cardiovascular diseases ,Myocardial infarction ,Survival rate ,Aged ,Heart Failure ,medicine.diagnostic_test ,business.industry ,Cardiogenic shock ,Percutaneous coronary intervention ,Reproducibility of Results ,Middle Aged ,medicine.disease ,Prognosis ,Survival Rate ,Heart failure ,Cohort ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Single-Chain Antibodies - Abstract
To evaluate quantitative relationships between baseline Q-wave width and 90-day outcomes in ST-segment elevation myocardial infarction (STEMI).Baseline Q-waves are useful in predicting clinical outcomes after MI.3589 STEMI patients were assessed from a multi-centre study.1156 patients of the overall cohort had pathologic Q-waves. The 90-day mortality and the composite of mortality, congestive heart failure (CHF), or cardiogenic shock (p0.001 for both outcomes) rose as Q-wave width increased. After adapting a threshold ≥40ms for inferior and ≥20ms for lateral/apical MI in all patients (n=3065) with any measureable Q-wave we found hazard ratios (HR) for mortality (HR: 2.44, 95% confidence interval (CI) (1.54-3.85), p0.001) and the composite (HR: 2.32, 95% CI (1.70-3.16), p0.001). This improved reclassification of patients experiencing the composite endpoint versus the conventional definition (net reclassification index (NRI): 0.23, 95% CI (0.09-0.36), p0.001) and universal MI definition (NRI: 0.15, 95% CI (0.02-0.29), p=0.027).The width of the baseline Q-wave in STEMI adds prognostic value in predicting 90-day clinical outcomes. A threshold of ≥40ms in inferior and ≥20ms for lateral/apical MI enhances prognostic insight beyond current criteria.
- Published
- 2014
57. ADEQUACY OF ANTICOAGULATION WITH ENOXAPARIN OR UNFRACTIONATED HEPARIN: THE CANADA PRIMARY PCI ANTICOAGULANT STREAM SUB-STUDY
- Author
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Warren J. Cantor, Yinggan Zheng, Wayne Tymchak, Cynthia M. Westerhout, F. Van de Werf, Robert C. Welsh, Paul W. Armstrong, and Neil Brass
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business.industry ,medicine.drug_class ,Anesthesia ,Conventional PCI ,Anticoagulant ,medicine ,Heparin ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Published
- 2015
58. Association of metabolic syndrome and its individual components with outcomes among patients with high-risk non-ST-segment elevation acute coronary syndromes
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Rajendra H. Mehta, Robert A. Harrington, Cynthia M. Westerhout, Kurt Huber, Kristin L Newby, Dorairaj Prabhakaran, Robert P. Giugliano, Paul W. Armstrong, Yinggan Zheng, and Early Acs Investigators
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Blood Glucose ,Male ,medicine.medical_specialty ,Population ,Kaplan-Meier Estimate ,Lower risk ,Body Mass Index ,Sex Factors ,Risk Factors ,Internal medicine ,Diabetes mellitus ,medicine ,Diabetes Mellitus ,Humans ,Obesity ,Acute Coronary Syndrome ,education ,Aged ,Metabolic Syndrome ,education.field_of_study ,business.industry ,Age Factors ,Middle Aged ,medicine.disease ,Blood pressure ,Endocrinology ,Treatment Outcome ,Cardiology ,Female ,Risk Adjustment ,Metabolic syndrome ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Dyslipidemia - Abstract
The relationship of metabolic syndrome and its individual components (obesity, hypertension, glucose intolerance, high triglycerides, and low high-density lipoprotein cholesterol) with 1-year mortality in non-ST-segment elevation acute coronary syndromes (NSTE ACS) patients is not known.The association of metabolic syndrome (and its individual components) with all-cause mortality within 1 year was assessed in NSTE ACS patients enrolled in the EARLY ACS trial. Adjusted hazard ratio (HR) and 95% CIs are reported.Of 9,406 patients, 2,596 (27.6%) had metabolic syndrome. Compared with those without metabolic syndrome, patients with this syndrome were younger, were more often female, and had a higher prevalence of comorbid conditions and higher-risk presenting features. Metabolic syndrome was not associated with increased 1-year mortality (HR 1.20, 95% CI 0.97-1.47; P = .09). The risk of 1-year mortality varied across the individual components: high-density lipoprotein40 mg/dL (men)/50 mg/dL (women; or dyslipidemia) was associated with higher risk (HR 1.52, 95% CI 1.15-2.02), and triglycerides150 mg/dL (or dyslipidemia) was associated with lower risk (HR 0.66, 95% CI 0.54-0.81), whereas the other components (ie, body mass index30 kg/m(2), fasting plasma glucose100 mg/dL or diabetes, systolic blood pressure130 mm Hg or diastolic85 mm Hg [or hypertension]) were associated with neutral risk of this event.The individual components of metabolic syndrome had varying associations with 1-year mortality, and as an integrated diagnosis, metabolic syndrome was not significantly associated with 1-year mortality. Thus, patient case-mix of the studied NSTE ACS population may influence the observed relationship of metabolic syndrome with subsequent cardiovascular events.
- Published
- 2013
59. Differences in treatment, outcomes, and quality of life among patients with heart failure in Canada and the United States
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Padma Kaul, Robert M. Califf, Adrian F. Hernandez, Christopher M. O'Connor, Randall C. Starling, Yanhong Li, Jean L. Rouleau, Jonathan G. Howlett, Paul W. Armstrong, Justin A. Ezekowitz, Yinggan Zheng, and Shelby D. Reed
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Male ,Pediatrics ,medicine.medical_specialty ,Canada ,Acute decompensated heart failure ,Health Status ,Population ,Quality of life ,Internal medicine ,Natriuretic Peptide, Brain ,medicine ,Humans ,education ,Aged ,Nesiritide ,Heart Failure ,education.field_of_study ,business.industry ,Odds ratio ,Length of Stay ,Middle Aged ,medicine.disease ,Confidence interval ,United States ,Clinical trial ,Treatment Outcome ,Heart failure ,Quality of Life ,Health Resources ,Female ,Natriuretic Agents ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Objectives The aim of this study was to compare clinical outcomes, resource utilization, and health-related quality of life between Canadian and U.S. patients enrolled in ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure). A further aim was to supplement the within-trial analysis with a contemporaneous population-based comparison of all patients hospitalized with primary diagnoses of heart failure (HF) in the 2 countries. Background Little is known about intercountry differences in outcomes of patients with HF in Canada and the United States. Methods Trial patients consisted of 465 Canadian and 2,684 U.S. patients enrolled in ASCEND-HF. Population-level cohorts consisted of 1.9 million U.S. and 81,016 Canadians hospitalized for HF in 2007 and 2008. Results Canadian patients in ASCEND-HF were older, were more likely to be white, and had lower body weights and blood pressures than U.S. patients. Canadians also had lower baseline-adjusted odds of 30-day mortality (odds ratio: 0.46; 95% confidence interval: 0.23 to 0.92) and better health-related quality of life than U.S. patients. In both countries, trial patients differed significantly from population-level cohorts. In contrast to ASCEND-HF, unadjusted in-hospital mortality at the population level was significantly lower in the United States (3.4%) compared with Canada (11.1%) (p Conclusions Intercountry differences in outcomes of patients hospitalized with HF differed significantly between trial and population cohorts. Further study on how cardiac care is delivered in the 2 countries and how it influences the results of clinical trials and population-level outcomes, especially in the long term, is warranted. (A Study Testing the Effectiveness of Nesiritide in Patients With Acute Decompensated Heart Failure; NCT00475852 )
- Published
- 2013
60. 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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van Diepen, Sean, Norris, Colleen M., Yinggan Zheng, Nagendran, Jayan, Graham, Michelle M., Ortega, Damaris Gaete, Townsend, Derek R., Ezekowitz, Justin A., Bagshaw, Sean M., Zheng, Yinggan, and Gaete Ortega, Damaris
- Published
- 2018
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61. Relationships Between Baseline Q Waves, Time From Symptom Onset, and Clinical Outcomes in ST-Segment- Elevation Myocardial Infarction Patients: Insights From the Vital Heart Response Registry.
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Yinggan Zheng, Bainey, Kevin R., Tyrrell, Benjamin D., Brass, Neil, Armstrong, Paul W., and Welsh, Robert C.
- Abstract
Background--Using a comprehensive ST-segment-elevation myocardial infarction registry, we evaluated the relationships of baseline Q waves, time from symptom onset, and reperfusion strategy with in-hospital clinical outcomes. Methods and Results--Consecutive ST-segment-elevation myocardial infarction patients from a defined health region were classified by the presence of baseline Q waves and additionally into primary percutaneous coronary intervention, fibrinolysis, or no reperfusion. ECGs were collected at baseline, after reperfusion, and analyzed for the presence of Q waves using Selvester criteria. Among 2290 ST-segment-elevation myocardial infarction patients, 36.9% had Q waves on their baseline ECG. Patients with Q waves were older (median age, 59 versus 57), were more often male (82.0% versus 75.4%), had higher heart rate (80 versus 72), had higher Global Registry of Acute Coronary Events risk score (129 versus 127), and were with longer time to reperfusion (42 minutes longer). They had higher composite end points (16.3% versus 10.0%), consistent across times from symptom onset to presentation (15.4% versus 9.9% =3 hours; 18.5% versus 8.9% >3 to =6 hours; 15.9% versus 11.3% >6 hours; Q and no Q, respectively). Baseline Q waves, but not time to reperfusion, were associated with an increased odds of the in-hospital composite end point of death, congestive heart failure, cardiogenic shock, and reinfarction (adjusted odds ratio, 1.65; 95% confidence interval, 1.18-2.30; P=0.003). Type of reperfusion did not modify the association of baseline Q waves and in-hospital outcomes (P interaction=0.918). Conclusions--The presence of baseline Q waves, rather than time to treatment, was significantly associated with adverse in-hospital events in real-world patients, regardless of reperfusion strategy used. [ABSTRACT FROM AUTHOR]
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- 2017
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62. Variations in practice and outcomes in patients undergoing primary percutaneous coronary intervention in the United States and Canada: insights from the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX AMI) trial
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Renato D. Lopes, Rajendra H. Mehta, Manesh R. Patel, Robert C. Welsh, Yinggan Zheng, Paul W. Armstrong, Christopher B. Granger, Karen S. Pieper, and Padma Kaul
- Subjects
Male ,medicine.medical_specialty ,Canada ,medicine.medical_treatment ,Myocardial Infarction ,Revascularization ,Antibodies, Monoclonal, Humanized ,Coronary Angiography ,Risk Assessment ,Electrocardiography ,Sex Factors ,Interquartile range ,Internal medicine ,Pexelizumab ,medicine ,Confidence Intervals ,Humans ,Myocardial infarction ,Hospital Mortality ,Angioplasty, Balloon, Coronary ,Practice Patterns, Physicians' ,Aged ,Proportional Hazards Models ,Analysis of Variance ,business.industry ,Hazard ratio ,Age Factors ,Percutaneous coronary intervention ,Length of Stay ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,United States ,Survival Rate ,Treatment Outcome ,Evaluation Studies as Topic ,Heart failure ,Conventional PCI ,Cardiology ,Female ,Stents ,Emergencies ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Follow-Up Studies ,Single-Chain Antibodies - Abstract
Background Information on practice patterns and outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary interventions (PCIs) in Canada vs United States is limited. Methods We evaluated differences in clinical and angiographic features, practice patterns, and outcomes between Canada and United States in 2,086 patients with ST-elevation myocardial infarction undergoing primary PCI in the APEX AMI trial. Results Of 2,086 patients, 335 (19%) were enrolled in Canada. Compared with US patients, Canadians were older with lower body mass index and creatinine clearance and less likely to have history of hypertension, smoking, or prior revascularization. Baseline infarct artery patency was higher, and the use of intra-aortic balloon pump and drug-eluting stents was lower in Canadian patients. Median door-to-PCI time was significantly shorter among Canadian patients (0.9 hours [interquartile range 0.6-1.3] vs 1.2 hours [interquartile range 0.8-1.7]). Clinical outcomes at 90 days were lower among Canadian patients, including shock (2.7% vs 4.2%), heart failure (3.6% vs 5.6%), bleeding (3.6% vs 9.6%), and atrial (3.6% vs 7.4%) and ventricular (3.0% vs 6.4%) arrhythmias. However, 90-day mortality (2.7% vs 4.8%, adjusted hazard ratio 0.62, 95% CI 0.47-1.28) and composite of death, shock, or heart failure (6.8% vs 11.5%, adjusted hazard ratio 0.77, 95% CI 0.47-1.27) were similar in the 2 cohorts. Conclusions Compared with US patients, Canadian patients had shorter door-to-PCI time but similar 90-day outcomes. These data suggest an opportunity for US sites to examine and learn from the Canadian systems of processes of care and implement changes so as to improve the timeliness of primary PCI.
- Published
- 2012
63. RELATIONSHIP BETWEEN ARTERIAL ACCESS AND OUTCOMES IN A PHARMACOINVASIVE VERSUS PRIMARY PCI STRATEGY IN ST-ELEVATION MYOCARDIAL INFARCTION: INSIGHTS FROM THE STRATEGIC REPERFUSION EARLY AFTER MYOCARDIAL INFARCTION (STREAM) STUDY
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Sigrun Halvorsen, Anthony H. Gershlick, Paul W. Armstrong, F. Van de Werf, Jay Shavadia, Phillippe Gabriel Steg, Kurt Huber, Robert C. Welsh, and Yinggan Zheng
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medicine.medical_specialty ,St elevation myocardial infarction ,business.industry ,Internal medicine ,Conventional PCI ,Cardiology ,medicine ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2015
64. Reduced dose tenecteplase and outcomes in elderly ST-segment elevation myocardial infarction patients: Insights from the STrategic Reperfusion Early After Myocardial infarction trial
- Author
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Renato D. Lopes, Frans Van de Werf, Yves Lambert, Peter Sinnaeve, Paul W. Armstrong, Thierry Danays, Erich Bluhmki, Cynthia M. Westerhout, Yinggan Zheng, and Fernado Rosell-Ortiz
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Population ,Myocardial Infarction ,Tenecteplase ,law.invention ,Electrocardiography ,Fibrinolytic Agents ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Myocardial infarction ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Cardiogenic shock ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Radiography ,Treatment Outcome ,Tissue Plasminogen Activator ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Intracranial Hemorrhages ,medicine.drug - Abstract
Background Elderly patients with ST-segment elevation myocardial infarction (STEMI) have worse outcomes and a greater risk of intracranial bleeding than nonelderly patients. Baseline characteristics, clinical outcomes, and the relationship of the tenecteplase (TNK) dose reduction to the efficacy, safety, and electrocardiographic indicators of reperfusion efficacy were evaluated in STEMI patients ≥75 years. Methods The STREAM trial evaluated early presenting STEMI patients who could not undergo primary percutaneous coronary intervention within 1 hour of first medical contact. Because of excess intracranial hemorrhage (ICH) in patients ≥75 years, the dose of TNK was reduced by 50%. Results Before dose amendment, there were 3 (7.1%) of 42 elderly patients with ICH; 2 of these were fatal, whereas no ICH occurred in the 93 elderly patients who received half-dose TNK postamendment. The median extent of ST-segment elevation resolution (≥50%) and proportion of patients with ≥2 mm in the electrocardiogram lead with greatest ST-segment elevation was comparable in elderly patients preamendment and postamendment (63.2% vs 56.0% and 43.6% vs 40.0%, respectively). Patients requiring rescue coronary intervention after TNK was also similar (42.9% vs 44.1%). The primary composite end point (30-day all-cause death, cardiogenic shock, congestive heart failure, and reinfarction) was 31.0% before versus 24.7% postamendment. Conclusions Our data, from a modest-sized population of elderly STEMI patients, indicate that half-dose TNK reduces the likelihood of ICH without compromising reperfusion efficacy. These observations are hypothesis generating and warrant further confirmation in randomized clinical trials in the elderly.
- Published
- 2015
65. MYOCARDIAL INFARCT SIZE AND SHOCK/HEART FAILURE: DOES REPERFUSION STRATEGY MATTER IN EARLY PRESENTING STEMIS?
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De Werf, N Dianati Maleki, Jay Shavadia, F. Van, Patrick Goldstein, Yinggan Zheng, and Paul W. Armstrong
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medicine.medical_specialty ,surgical procedures, operative ,business.industry ,Internal medicine ,medicine ,Cardiology ,cardiovascular diseases ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Shock heart - Abstract
ECGs and accurate STEMI diagnosis (r1⁄4 0.482, p 20 ECGs read per week showed statistically significant improvement in accuracy (P 20 ECGs per week was shown to significantly improve STEMI diagnosis, regardless of underlying training. Increased training and paramedic exposure to ECG interpretation may improve STEMI diagnosis and decrease false positive CCL activation.
- Published
- 2014
66. Implications of ischaemic area at risk and mode of reperfusion in ST-elevation myocardial infarction.
- Author
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Bainey, Kevin R., Fresco, Claudio, Yinggan Zheng, Halvorsen, Sigrun, Carvalho, Antonio, Ostojic, Miodrag, Goldstein, Patrick, Gershlick, Anthony H., Westerhout, Cynthia M., Van de Werf, Frans, Armstrong, Paul W., Zheng, Yinggan, and STREAM Investigators
- Subjects
MYOCARDIAL infarction ,MYOCARDIAL reperfusion ,PERCUTANEOUS coronary intervention ,CORONARY disease ,FIBRINOLYSIS ,MYOCARDIAL infarction diagnosis ,MYOCARDIAL infarction-related mortality ,MYOCARDIAL infarction treatment ,CARDIOVASCULAR system ,COMPARATIVE studies ,ELECTROCARDIOGRAPHY ,RESEARCH methodology ,MEDICAL care ,MEDICAL care research ,MEDICAL cooperation ,HEALTH outcome assessment ,RESEARCH ,RISK assessment ,SURVIVAL analysis (Biometry) ,TICLOPIDINE ,TIME ,EVALUATION research ,RANDOMIZED controlled trials ,TREATMENT effectiveness ,PLATELET aggregation inhibitors ,ENOXAPARIN - Abstract
Objective: Uncertainty exists concerning the relative merits of pharmacological versus mechanical coronary reperfusion in patients presenting early with ST-elevation myocardial infarction (STEMI) with extensive myocardium at risk. Accordingly, we investigated whether the extent of baseline ST-segment shift was related to the response of either reperfusion modality in patients with STEMI presenting within 3 h of symptoms.Methods: We analysed baseline ECGs from 1859 patients enrolled in the STrategic Reperfusion Early After Myocardial Infarction (STREAM) trial. The sum of ST-segment elevation (∑STE) and ST-segment deviation (∑STD) was categorised into quartiles and associations with the primary endpoint (30-day death/shock/congestive heart failure/re-myocardial infarction) for each reperfusion strategy (early fibrinolysis vs primary percutaneous coronary intervention) were explored.Results: Overall, there was a progressive rise in the 30-day primary endpoint according to quartiles of baseline ∑STE (10.3% (0-5 mm), 12.4% (5.5-8.5 mm), 12.1% (9-13.5 mm), 17.6% (> 14.0 mm), p = 0.008) and ∑STD (9.0% (0-9 mm), 13.5% (9.5-14 mm), 14.7% (14.5-20 mm), 15.3% (> 20 mm), p = 0.019). Both ∑STE and ∑STD were associated with the primary endpoint (∑STE: p = 0.071; ∑STD: p = 0.024). However, there was no interaction between quartiles of baseline ∑STE or ∑STD and efficacy of either reperfusion strategy on the 30-day clinical outcomes (∑STE: p (interaction) = 0.696; ∑STD: p (interaction) = 0.542).Conclusions: These data demonstrate an association between ∑STE or ∑STD on the baseline ECG and clinical events at 30 days following reperfusion therapy in STEMI. More importantly, the response to different reperfusion strategies was not influenced by the extent of jeopardised myocardium.Trial Registration Number: NCT00623623; Post-results. [ABSTRACT FROM AUTHOR]- Published
- 2016
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67. Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial.
- Author
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Maleki, Neda Dianati, Van de Werf, Frans, Goldstein, Patrick, Adgey, Jennifer A., Lambert, Yves, Sulimov, Vitaly, Rosell-Ortiz, Fernando, Gershlick, Anthony H., Yinggan Zheng, Westerhout, Cynthia M., and Armstrong, Paul W.
- Subjects
MYOCARDIAL infarction ,REPERFUSION ,ELECTROCARDIOGRAPHY ,TENECTEPLASE ,ANGIOPLASTY ,CORONARY artery surgery - Abstract
Background We evaluated the prespecified endpoint, aborted myocardial infarction (AbMI), according to the use of a pharmacoinvasive (PI) strategy versus primary percutaneous coronary intervention (PCI) in 1754 patients randomised within 3 h of symptom onset in the STrategic Reperfusion Early After Myocardial infarction (STREAM) trial. Methods Based on sequential ECG's and biomarkers, AbMI was defined as ST-elevation resolution =50% (90 min posttenecteplase (TNK) in the PI arm or 30 min postprimary PCI) with minimal biomarker rise. Results In the PI arm 11.1% (n=99) had AbMI versus 6.9% (n=59) in primary PCI arm ( p<0.01). In a multivariable model, AbMI patients overall had less baseline SST-deviation, fewer baseline Q-waves and shorter total ischaemic times. PI AbMI patients had faster time to TNK (90 vs 100 min, p=0.015): total ischaemic time was 100 min longer in primary PCI AbMI patients and no difference in ischaemic time existed between AbMI and non-AbMI patients within this group. Although no significant interaction between treatment and AbMI on the composite endpoint of death/shock/congestive heart failure/recurrent MI occurred (p=0.292), PI AbMI patients had a lower incidence in this endpoint than non- AbMI patients (5.1 vs 12%, p=0.038); this was not evident in primary PCI patients. Forty-five patients (ie, 2.5%) had masquerading MI with minimal biomarker elevation and no evolution in baseline ST-elevation. Conclusions A PI strategy of early fibrinolysis more frequently aborts MI than primary PCI. Such PI patients had more favourable outcomes as compared with non- AbMIs. Diligent review of ECG evolution in STEMI distinguishes AbMI from infarct masquerade. Clinical Trials.gov ID NCT00623623. [ABSTRACT FROM AUTHOR]
- Published
- 2014
- Full Text
- View/download PDF
68. Association of metabolic syndrome and its individual components with outcomes among patients with high-risk non-ST-segment elevation acute coronary syndromes.
- Author
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Mehta, Rajendra H., Westerhout, Cynthia M., Yinggan Zheng, Giugliano, Robert P., Huber, Kurt, Prabhakaran, Dorairaj, Harrington, Robert A., Newby, Kristin L., and Armstrong, Paul W.
- Abstract
Background The relationship of metabolic syndrome and its individual components (obesity, hypertension, glucose intolerance, high triglycerides, and low high-density lipoprotein cholesterol) with 1-year mortality in non-ST-segment elevation acute coronary syndromes (NSTE ACS) patients is not known. Methods The association of metabolic syndrome (and its individual components) with all-cause mortality within 1 year was assessed in NSTE ACS patients enrolled in the EARLY ACS trial. Adjusted hazard ratio (HR) and 95% CIs are reported. Results Of 9,406 patients, 2,596 (27.6%) had metabolic syndrome. Compared with those without metabolic syndrome, patients with this syndrome were younger, were more often female, and had a higher prevalence of comorbid conditions and higher-risk presenting features. Metabolic syndrome was not associated with increased 1-year mortality (HR 1.20, 95% CI 0.97-1.47; P = .09). The risk of 1-year mortality varied across the individual components: high-density lipoprotein <40 mg/dL (men)/<50 mg/dL (women; or dyslipidemia) was associated with higher risk (HR 1.52, 95% CI 1.15-2.02), and triglycerides >150 mg/dL (or dyslipidemia) was associated with lower risk (HR 0.66, 95% CI 0.54-0.81), whereas the other components (ie, body mass index >30 kg/m², fasting plasma glucose >100 mg/dL or diabetes, systolic blood pressure >130 mm Hg or diastolic >85 mm Hg [or hypertension]) were associated with neutral risk of this event. Conclusions The individual components of metabolic syndrome had varying associations with 1-year mortality, and as an integrated diagnosis, metabolic syndrome was not significantly associated with 1-year mortality. Thus, patient case-mix of the studied NSTE ACS population may influence the observed relationship of metabolic syndrome with subsequent cardiovascular events. # [ABSTRACT FROM AUTHOR]
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- 2014
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69. Prognostic implications of quantitative evaluation of baseline Q-wave width in ST-segment elevation myocardial infarction.
- Author
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Bao, Mike H., Yinggan Zheng, Westerhout, Cynthia M., Yuling Fu, Wagner, Galen S., Chaitman, Bernard, Granger, Christopher B., and Armstrong, Paul W.
- Abstract
Objectives To evaluate quantitative relationships between baseline Q-wave width and 90-day outcomes in ST-segment elevation myocardial infarction (STEMI). Background Baseline Q-waves are useful in predicting clinical outcomes after MI. Methods 3589 STEMI patients were assessed from a multi-centre study. Results 1156 patients of the overall cohort had pathologic Q-waves. The 90-day mortality and the composite of mortality, congestive heart failure (CHF), or cardiogenic shock (p < 0.001 for both outcomes) rose as Q-wave width increased. After adapting a threshold ≥ 40 ms for inferior and ≥ 20 ms for lateral/apical MI in all patients (n = 3065) with any measureable Q-wave we found hazard ratios (HR) for mortality (HR: 2.44, 95% confidence interval (CI) (1.54-3.85), p < 0.001) and the composite (HR: 2.32, 95% CI (1.70-3.16), p < 0.001). This improved reclassification of patients experiencing the composite endpoint versus the conventional definition (net reclassification index (NRI): 0.23, 95% CI (0.09-0.36), p < 0.001) and universal MI definition (NRI: 0.15, 95% CI (0.02-0.29), p = 0.027). Conclusions The width of the baseline Q-wave in STEMI adds prognostic value in predicting 90-day clinical outcomes. A threshold of ≥ 40 ms in inferior and ≥ 20 ms for lateral/apical MI enhances prognostic insight beyond current criteria. [ABSTRACT FROM AUTHOR]
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- 2014
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70. Baseline Q waves as a prognostic modulator in patients with ST-segment elevation: insights from the PLATO trial.
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Siha, Hany, Das, Debraj, Yuling Fu, Yinggan Zheng, Westerhout, Cynthia M., Storey, Robert F., James, Stefan, Wallentin, Lars, and Armstrong, Paul W.
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ACUTE coronary syndrome ,ELECTROCARDIOGRAPHY ,MORTALITY ,MULTIVARIATE analysis ,CONFIDENCE intervals ,HEALTH outcome assessment - Abstract
Background: Baseline Q waves may provide additional value compared with time from the onset of symptoms in predicting outcomes for patients with ST-segment elevation. We evaluated whether baseline Q waves superseded time from symptom onset as a prognostic marker of one-year mortality in patients with ST-segment elevation acute coronary syndrome. Our study was derived from data from patients undergoing primary percutaneous coronary intervention within 24 hours in the PLATelet inhibition and patient Outcomes trial Methods: Q waves on the baseline electrocardiogram were evaluated by a blinded core laboratory. We assessed the associations between baseline Q waves and time from symptom onset to percutaneous coronary intervention with peak biomarkers, ST-segment resolution on the discharge electrocardiogram, and one-year all-cause and vascular mortality. Results: Of 4341 patients with ST-segment elevation, 46% had baseline Q waves. Compared to those without Q waves, those with baseline Q waves were older, more frequently male, had higher heart rates, more advanced Killip class and had a longer time between the onset of symptoms and percutaneous coronary intervention. They also had higher one-year all-cause mortality than patients without baseline Q waves (baseline Q waves: 4.9%; no baseline Q waves: 2.8%; hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.29-2.45, p < 0.001). Complete ST-segment resolution was greatest and all-cause mortality lowest among those with symptom onset three hours or less before percutaneous coronary intervention and no baseline Q waves. After multivariable adjustment, baseline Q waves, but not time from symptom onset, were associated with a significant increase in all-cause mortality (adjusted HR 1.42, 95% CI 1.10-2.01, p = 0.046) and vascular mortality (adjusted HR 1.58, 95% CI 1.09-2.28, p = 0.02). Interpretation: The presence of baseline Q waves provides useful additional prognostic insight into the clinical outcome of patients with ST-segment elevation. [ABSTRACT FROM AUTHOR]
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- 2012
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71. Using the Attribute Hierarchy Method to Identify and Interpret Cognitive Skills that Produce Group Differences.
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Gierl, Mark J., Yinggan Zheng, and Ying Cui
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PSYCHOMETRICS , *PSYCHOLOGICAL techniques , *TASK performance , *NEURAL computers , *HIERARCHY of needs theory (Psychology) , *MATHEMATICAL logic - 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. [ABSTRACT FROM AUTHOR]
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- 2008
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72. Dietary fatty acids intake and mortality in patients with heart failure.
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Colin-Ramirez, Eloisa, Castillo-Martinez, Lilia, Orea-Tejeda, Arturo, Yinggan Zheng, Westerhout, Cynthia M., and Ezekowitz, Justin A.
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HEART failure treatment , *HEART beat , *ADRENERGIC beta blockers , *ACE inhibitors , *ASPIRIN , *BODY weight , *CARDIAC output , *DIET , *DIURETICS , *DRINKING (Physiology) , *FATTY acids , *HEART diseases , *CARDIAC patients , *HEART failure , *HEMOGLOBINS , *ANTIHYPERTENSIVE agents , *MEDICAL care , *EVALUATION of medical care , *NUTRITION , *NUTRITIONAL requirements , *PATIENTS , *POTASSIUM , *SODIUM , *MICRONUTRIENTS , *DATA analysis , *ALBUMINS , *BODY mass index , *KAPLAN-Meier estimator , *DIAGNOSIS - Abstract
Objective: Dietary strategies in heart failure (HF) are focused on sodium and fluid restriction to minimize the risk for acute volume overload episodes. However, the importance of dietary factors beyond sodium intake in the prognosis of the disease is uncertain. The purpose of this study was to evaluate the association of macro- and micronutrients intake on 1-y mortality in patients with HF. Methods: A secondary analysis of 203 patients with chronic HF enrolled in a randomized trial of sodium reduction was completed. Patients with a complete 3-d food record at baseline were included in this analysis (N = 118); both control and intervention arms were combined. Three-d mean dietary intake was estimated. Cox multivariable regression analysis was used to evaluate the association between dietary factors and 1-y mortality. Results: Among the 118 included patients, 54% were men, median (25th-75th percentiles) age 66 y (52-75 y), median ejection fraction 45% (30%-60%), and ischemic etiology present in 49% of patients. The association with 1-y mortality was significant for both polyunsaturated fatty acids (PUFA; adjusted hazard ratio [HR], 0.67; 95% confidence interval [CI]. 0.51-0.86 for intake as percentage of daily energy) and saturated fatty acids (SFA; adjusted HR, 1.15; 95% CI, 1.03-1.30 for intake as percentage of daily energy). Median of intake as percentage of daily energy was 5.3% for PUFAs and 8.2% for SFAs. Conclusions: Intake of PUFAs and SFAs was independently associated with 1 -y all-cause mortality in patients with chronic HF. Limiting dietary SFA and increasing PUFA intake may be advisable in this population. [ABSTRACT FROM AUTHOR]
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- 2014
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