26 research outputs found
Stroke in Patients With Acute Coronary Syndromes: Incidence and Outcomes in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial
BACKGROUND: The incidence of stroke in patients with acute coronary
syndromes has not been clearly defined because few trials in this patient
population have been large enough to provide stable estimates of stroke
rates. METHODS AND RESULTS: We studied the 10 948 patients with acute
coronary syndromes without persistent ST-segment elevation who were
randomly assigned to placebo or the platelet glycoprotein IIb/IIIa
receptor inhibitor eptifibatide in the Platelet Glycoprotein IIb/IIIa in
Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT)
trial to determine stroke rates, stroke types, clinical outcomes in
patients with stroke, and independent baseline clinical predictors for
nonhemorrhagic stroke. Stroke occurred in 79 (0.7%) patients, with 66
(0.6%) nonhemorrhagic, 6 intracranial hemorrhages, 3 cerebral infarctions
with hemorrhagic conversion, and 4 of uncertain cause. There were no
differences in stroke rates between patients who received placebo and
those assigned high-dose eptifibatide (odds ratios and 95% confidence
intervals 0.82 [0.59, 1.14] and 0.70 [0.49, 0.99], respectively). Of the
79 patients with stroke, 17 (22%) died within 30 days, and another 26
(32%) were disabled by hospital discharge or 30 days, whichever came
first. Higher heart rate was the most important baseline clinical
predictor of nonhemorrhagic stroke, followed by older age, prior anterior
myocardial infarction, prior stroke or transient ischemic attack, and
diabetes mellitus. These factors were used to develop a simple scoring
nomogram that can predict the risk of nonhemorrhagic stroke. CONCLUSIONS:
Stro
Cost-effectiveness of alirocumab in patients with acute coronary syndromes the ODYSSEY OUTCOMES trial
BACKGROUND Cholesterol reduction with proprotein convertase subtitisin-kexin type 9 inhibitors reduces ischemic events; however, the cost-effectiveness in statin-treated patients with recent acute coronary syndrome remains uncertain.OBJECTIVES This study sought to determine whether further cholesterol reduction with atirocumab would be cost-effective in patients with a recent acute coronary syndrome on optimal statin therapy.METHODS A cost-effectiveness model leveraging patient-level data from ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Atirocumab) was developed to estimate costs and outcomes over a lifetime horizon. Patients (n = 18,924) had a recent acute coronary syndrome and were on high-intensity or maximum-tolerated statin therapy, with a baseline tow-density lipoprotein cholesterol (LDL-C) level >= 70 mg/l, non-high-density lipoprotein cholesterol >= 100 mg/dl, or apotipoprotein B >= 80 mg/l. Atirocumab 75 mg or placebo was administered subcutaneously every 2 weeks. Atirocumab was blindly titrated to 150 mg if LDL-C remained >= 50 mg/dl or switched to placebo if 2 consecutive LDL-C levels were = 100 mg/dl.RESULTS Across the overall population recruited to the ODYSSEY OUTCOMES trial, using an annual treatment cost of US92,200 per QALY (base case). The cost was US299,400. Among patients with LDL-C a100 mg/dl, incremental cost-effectiveness ratios remained below US$100,000 per QALY across a wide variety of sensitivity analyses.CONCLUSIONS In patients with a recent acute coronary syndrome on optimal statin therapy, atirocumab improves cardiovascular outcomes at costs considered intermediate value, with good value in patients with baseline LDL-C mg/dt but less economic value with LDL-C >= 100 mg/dl. (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Atirocumab [ODYSSEY OUTCOMES]; NCT01663402) (J Am Colt Cardiol 2020;75:2297-308) (C) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.Cardiolog
Association between minor elevations of creatine kinase-MB level and mortality in patients with acute coronary syndromes without ST-segment elevation.
CONTEXT: Controversy surrounds the diagnostic and prognostic importance of
slightly elevated cardiac markers in patients with acute coronary
syndromes without ST-segment elevation. OBJECTIVES: To investigate the
relationship between peak creatine kinase (CK)-MB level and outcome and to
determine whether a threshold CK-MB level exists below which risk is not
increased. DESIGN AND SETTING: Retrospective observational analysis of
data from the international Platelet Glycoprotein IIb/IIIa in Unstable
Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial,
conducted from November 1995 to January 1997. PATIENTS: A total of 8250
patients with acute coronary syndromes without ST-segment elevation who
had at least 1 CK-MB sample collected during their index hospitalization.
MAIN OUTCOME MEASURE: Mortality at 30 days and 6 months, was assessed by
category of index-hospitalization peak CK-MB level (0-1, >1-2, >2-3, >3-5,
>5-10, or >10 times the upper limit of normal). Multivariable logistic
regression was used to determine the independent prognostic significance
of peak CK-MB level after adjustment for baseline predictors of 30-day and
6-month mortality. RESULTS: Mortality at 30 days and 6 months increased
from 1.8% and 4.0%, respectively, in patients with normal peak CK-MB
levels, to 3.3% and 6.2 % at peak CK-MB levels 1 to 2 times normal, to
5.1% and 7.5% at peak CK-MB levels 3 to 5 times normal, and to 8.3% and
11.0% at peak CK-MB levels greater than 10 times normal. Log-transformed
peak CK-MB levels were predictive of adjusted 30-day and 6-month mortality
(P<.001 for both). CONCLUSIONS: Our data show that elevation of CK-MB
level is strongly related to mortality in patients with acute coronary
syndromes without ST-segment elevation, and that the increased risk begins
with CK-MB levels just above normal. In the appropriate clinical context,
even minor CK-MB elevations should be considered indicative of myocardial
infarction
Mesoscale eddies drive increased silica export in the subtropical Pacific Ocean
Mesoscale eddies may play a critical role in ocean biogeochemistry by increasing nutrient supply, primary production, and efficiency of the biological pump, that is, the ratio of carbon export to primary production in otherwise nutrient-deficient waters. We examined a diatom bloom within a cold-core cyclonic eddy off Hawai`i. Eddy primary production, community biomass, and size composition were markedly enhanced but had little effect on the carbon export ratio. Instead, the system functioned as a selective silica pump. Strong trophic coupling and inefficient organic export may be general characteristics of community perturbation responses in the warm waters of the Pacific Ocean