The human bovine arch—a common misnomer

No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56092/1/21086_ftp.pd

Using Propensity Score Matching in Clinical Investigations: A Discussion and Illustration

Propensity score matching is a useful tool to analyze observational data in clinical investigations, but it is often executed in an overly simplistic manner, failing to use the data in the best possible way. This review discusses current best practices in propensity score matching, outlining the method's essential steps, including appropriate post-matching balance assessments and sensitivity analyses. These steps are summarized as eight key traits of a propensity matched study. Further, this review illustrates these traits through a case study examining the impact of access site in percutaneous coronary intervention (PCI) procedures on bleeding complications. Through propensity score matching, we find that bleeding occurs significantly less often with radial access procedures, though many other outcomes show no significant difference by access site, a finding that mirrors the results of randomized controlled trials. Lack of attention to methodological principles can result in results that are not biologically plausible

Current Approach to the Diagnosis and Treatment of Femoral-Popliteal Arterial Disease. A Systematic Review

Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis affecting 5 million adults in the United States, with an age-adjusted prevalence of 4% to 15% and increasing up to 30% with age and the presence of cardiovascular risk factors. In this article we focus on lower extremity PAD and specifically on the superficial femoral and proximal popliteal artery (SFPA), which are the most common anatomic locations of lower extremity atherosclerosis. We summarize current evidence and perform a systematic review on the diagnostic evaluation as well as the medical, endovascular and surgical management of SFPA disease

Failure of Guideline Adherence for Intervention in Patients With Severe Mitral Regurgitation

ObjectivesThis study sought to evaluate the incidence with which adult patients with significant mitral regurgitation (MR) do not undergo surgical intervention despite guideline recommendations, and the associated considerations resulting in no intervention.BackgroundDespite the existence of accepted guidelines, many patients with severe symptomatic heart valve disease might not undergo intervention.MethodsAt a single large tertiary medical center, patients were retrospectively identified who had moderate-to-severe or severe MR on echocardiographic imaging during 2005. Clinical data were reviewed to determine indications for intervention and whether surgery was performed.ResultsDuring 2005, 300 patients were identified with significant MR, including 188 with functional MR and 112 with organic MR. Mitral surgery was performed in 30 of 188 patients with functional MR, mostly to treat heart failure or during another cardiac surgical procedure. Mitral surgery was performed in 59 (53%) of 112 patients with organic MR. Among unoperated patients with organic MR, common reasons included stable left ventricular size or function, absence of symptoms, and prohibitive comorbidities. Using American College of Cardiology/American Heart Association guidelines, 1 or more indication for intervention was present in 39 (74%) of 53 unoperated patients. Perioperative mortality risk was not higher for patients who did not undergo surgery (median 1.2%, interquartile range [IQR] 0.4% to 3.3%) than for those who did (median 1.1%, IQR 0.6% to 5.3%; p = 0.71). During follow-up, there were 12 cardiac and 2 unexplained deaths.ConclusionsAmong patients with severe organic MR, surgical intervention occurred in approximately one-half. However, accepted guideline indications for intervention were present in the majority of unoperated patients. Objectively assessed operative risk was not prohibitive in many unoperated patients

Short term and intermediate term comparison of endarterectomy versus stenting for carotid artery stenosis: systematic review and meta-analysis of randomised controlled clinical trials

Objective To evaluate the relative short term safety and intermediate term efficacy of carotid endarterectomy versus carotid artery stenting

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

Trends and Outcomes During Rollout Phase of Non-Primary PCI at Sites Without Surgery On-Site: The Michigan Experience

Objectives: This study sought to compare outcomes of patients undergoing non-primary percutaneous coronary intervention (non-PPCI) at centers with and without surgery on-site (SoS) in Michigan during the introductory phase.Background: Non-PPCI recently received certificate of need approval in the state of Michigan to be performed at sites without SoS. This requires mandatory participation in the BMC2 registry, which involves rigorous quality oversight. Methods: Consecutive patients who underwent non-PPCI at 47 hospitals in Michigan from April 2016 to March 2018 were included. From this cohort, 4,643 propensity matched patients, in a 1:1 fashion, were used to compare baseline characteristics, procedural details, and in-hospital outcomes. Additionally, trends in non-PPCI distribution among sites were assessed.Results: Of the 61,864 PCI’s performed during the study period, 50,817 were non-PPCI’s, with 46,096 (90.7%) performed at sites with SoS and 4,721 (9.3%) at sites without SoS. While overall PCI volume remained relatively steady, there was a near three-fold rise in performance of non-PPCI at sites without SoS. In propensity matched cohorts, overall rate of major adverse cardiac events (2.6% vs. 2.8%; p = 0.443), in-hospital mortality (0.6% vs. 0.5%; p = 0.465), and other secondary clinical and quality outcomes, showed no clinically significant differences. Conclusion: In the two years since state approval, non-primary PCI at centers without cardiac SoS was associated with similar in-hospital outcomes and quality compared with centers with SoS. The mandatory rigorous quality oversight process that was put in place by state regulations can serve as a model for similar programs elsewhere.https://scholarlycommons.henryford.com/merf2019clinres/1002/thumbnail.jp

The comparative safety and effectiveness of bivalirudin versus heparin monotherapy in patients on dialysis undergoing percutaneous coronary intervention: Insights from the Blue Cross Blue Shield of Michigan cardiovascular consortium

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139064/1/ccd27001.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139064/2/ccd27001_am.pd