The Clinical Outcomes of Percutaneous Coronary Intervention Performed Without Pre-Procedural Aspirin

ObjectivesThe purpose of this study was to examine the incidence and outcomes of percutaneous coronary intervention (PCI) performed in patients who had not received pre-procedural aspirin.BackgroundAspirin is an essential component of peri-PCI pharmacotherapy. Previous studies suggest that pre-procedural aspirin is not administered to a clinically significant number of patients undergoing PCI.MethodsWe evaluated the incidence of PCIs performed without pre-procedural aspirin use among patients undergoing PCI from January 2010 through December 2011 at 44 hospitals in Michigan. Propensity-matched multivariate analysis was used to adjust for the nonrandom use of aspirin.ResultsOur study population comprised 65,175 patients, of whom 4,640 (7.1%) did not receive aspirin within 24 h before undergoing PCI. Aspirin nonreceivers were more likely to have had previous gastrointestinal bleeding or to present with cardiogenic shock or after cardiac arrest. In the propensity-matched analysis, absence of aspirin before PCI was associated with a higher rate of death (3.9% vs. 2.8%; odds ratio: 1.89 [95% confidence interval: 1.32 to 2.71], p < 0.001) and stroke (0.5% vs. 0.1%; odds ratio: 4.24 [95% confidence interval: 1.49 to 12.11], p = 0.007) with no difference in need for transfusions. This association was consistent across multiple pre-specified subgroups.ConclusionsA significant number of patients do not receive aspirin before undergoing PCI. Lack of aspirin before PCI was associated with significantly increased in-hospital mortality and stroke. Our study results support the need for quality efforts focused on optimizing aspirin use before PCI

THE POWER OF A PROCEDURALIST: PRESCRIBING GUIDELINE–BASED MEDICAL THERAPY PRIOR TO HOSPITAL DISCHARGE INCREASES COMPLIANCE AT SIX MONTHS IN PATIENTS WITH SEVERE PERIPHERAL ARTERY DISEASE

Corberó, XavierPrimer pla de la Font de la Corporació Metropolitana de Barcelona, situada al Torrent de l'Olla. Obra de Xavier Corberó (1985) dins de l'homenatge a Joan Maragall

The Epidemiology and Outcomes of Percutaneous Coronary Intervention Before High‐Risk Noncardiac Surgery in Contemporary Practice: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Registry

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139074/1/jah3534.pd

Not just phonology: a longitudinal study of dyslexia subtypes based on the distinction between reading accuracy and reading rate

IntroductionPrevious cross-sectional investigations by Shany and colleagues have provided evidence of double dissociation among dyslexics between word reading accuracy and (pure) word reading rate. A rate-disabled subtype (with intact reading accuracy) evinced deficits only in rapid naming (RAN); An accuracy-disabled subtype (with intact reading rate) showed deficits in phonological awareness (PA) and morphological awareness (MA) but not RAN.MethodThe present longitudinal study followed 639 Palestinian Arabic-speaking children from preschool to Grade 1 with the aim of determining (1) whether a dissociation between PA C MA and RAN is apparent among pre-literate preschoolers, (2) whether the PA C MA-disabled subgroup constitutes a mild form of Developmental Language Disorder (DLD), (3) whether our three disabled subgroups (PA C MA-only, RAN-only, and PA C MA-plus-RAN) can be differentiated on preschool early literacy measures and, (4) whether the three at-risk subgroups develop into selectively rate-disabled, accuracy-disabled, or doubly-disabled (accuracy C rate) readers in Grade 1?ResultsOur findings confirmed the existence of two distinct selectively disabled/at-risk subgroups in preschool: a RAN-only subgroup with intact PA and MA and a PA C MA subgroup with broad impairments across language measures but intact RAN. Grade 1 reading data also confirmed that the RAN-disabled subgroup became slow but accurate readers, whereas the PA C MA subgroup developed into inaccurate and slow readers.DiscussionOur study indicates partial dissociation between early dyslexia subtypes, each displaying distinct and non-overlapping cognitive-linguistic profiles in preschool. The study also revealed a strong association between reading accuracy and reading rate among beginning readers. This study emphasizes the importance of considering heterogeneity in reading outcomes as well as multiple oral language skills beyond the well-documented role of PA

Improving Heart Failure Self-Management Support by Actively Engaging Out-of-Home Caregivers: Results of a Feasibility Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72336/1/j.1751-7133.2008.07474.x.pd

Insights from Eye Blinks into the Cognitive Processes Involved in Visual Word Recognition

Behavioral differences in speed and accuracy between reading familiar and unfamiliar words are well-established in the empirical literature. However, these standard measures of skill proficiency are limited in their ability to capture the moment-to-moment processing involved in visual word recognition. In the present study, the effect of word familiarity was initially investigated using an eye blink rate among adults and children. The probability of eye blinking was higher for familiar (real) words than for unfamiliar (pseudo)words. This counterintuitive pattern of results suggests that the processing of unfamiliar (pseudo)words is more demanding and perhaps less rewarding than the processing of familiar (real) words, as previously observed in both behavioral and pupillometry data. Our findings suggest that the measurement of eye blinks might shed new light on the cognitive processes involved in visual word recognition and other domains of human cognition

Temporal Trends in the Use of Drug-eluting Stents for Approved and Off-label Indications: A Longitudinal Analysis of a Large Multicenter Percutaneous Coronary Intervention Registry

Background We sought to examine the temporal variations in the rate of both bare-metal stent (BMS) and drug-eluting stent (DES) use for off-label indications after the reports of an increased risk of very late stent thrombosis in patients with DES at the 2006 meeting of the European Society of Cardiology (ESC). Hypothesis To determine whether the decrease in use of DES has affected both on and off-label indications. Methods The study cohort included patients undergoing coronary intervention in a large regional registry, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Patient demographic and clinical characteristics for patients with DES in the third quarter of 2006 (pre-ESC) were compared to those from the fourth quarter of 2008 (post-guideline changes). Use of DES for off-label indications, such as ST-segment elevation myocardial infarction (STEMI), in-stent restenosis (ISR), and saphenous vein graft (SVG) interventions, were evaluated. Results The overall deployment of DES fell sharply from 83% pre-ESC to a plateau of 58% in the first quarter of 2008. This corresponded to a rise in BMS use, while angioplasty procedures stayed the same. The STEMI subgroup showed the most dramatic change, from 78% to only 36%. Off-label use in SVGs showed a similar trend, from 74% to 43%. Drug-eluting stent deployment for ISR was less affected, though it also fell 25% (from 79%–56%). Conclusions The use of DES has fallen dramatically from June 2006 to December 2008, particularly for nonapproved indications. Our study provides a real-world assessment of contemporary change in DES use in response to the presentation of negative observational studies. Copyright © 2010 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65057/1/20717_ftp.pd

Relationship Between Operator Volume and Adverse Outcome in Contemporary Percutaneous Coronary Intervention Practice An Analysis of a Quality-Controlled Multicenter Percutaneous Coronary Intervention Clinical Database

ObjectivesThe aim of our study was to evaluate the volume-outcome relationship in a large, quality-controlled, contemporary percutaneous coronary interventions (PCI) database.BackgroundWhether the relationship between physician volume of PCI and outcomes still exists in the era of coronary stents is unclear.MethodsData on 18,504 consecutive PCIs performed by 165 operators in calendar year 2002 were prospectively collected in a regional consortium. Operators' volume was divided into quintiles (1 to 33, 34 to 89, 90 to 139, 140 to 206, and 207 to 582 procedures/year). The primary end point was a composite of major adverse cardiovascular events (MACE) including death, coronary artery bypass grafting, stroke or transient ischemic attack, myocardial infarction, and repeat PCI at the same site during the index hospital stay.ResultsThe unadjusted MACE rate was significantly higher in quintiles one and two of operator volume when compared with quintile five (7.38% and 6.13% vs. 4.15%, p = 0.002 and p = 0.0001, respectively). A similar trend was observed for in-hospital death. After adjustment for comorbidities, patients treated by low volume operators had a 63% increased odds of MACE (adjusted odds ratio [OR] 1.63, 95% confidence interval [CI] 1.29 to 2.06, p < 0.0001 for quintile [Q]1; adjusted OR 1.63, 95% CI 1.34 to 1.90, p < 0.0001 for Q2 vs. Q5), but not of in-hospital death. Overall, high volume operators had better outcomes than low volume operators in low-risk and high-risk patients.ConclusionsAlthough the relationship between operator volume and in-hospital mortality is no longer significant, the relationship between volume and any adverse outcome is still present. Technological advancements have not yet completely offset the influence of procedural volume on proficiency of PCIs