38 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
Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes.
AIM: To study the relationship between outcomes and peak creatine kinase (CK)-MB levels after percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation acute coronar
Alirocumab Reduces Total Nonfatal Cardiovascular and Fatal Events : The ODYSSEY OUTCOMES Trial
The ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial compared alirocumab with placebo, added to high-intensity or maximum-tolerated statin treatment, after acute coronary syndrome (ACS) in 18,924 patients. Alirocumab reduced the first occurrence of the primary composite endpoint and was associated with fewer all-cause deaths. This pre-specified analysis determined the extent to which alirocumab reduced total (first and subsequent) nonfatal cardiovascular events and all-cause deaths in ODYSSEY OUTCOMES. Hazard functions for total nonfatal cardiovascular events (myocardial infarction, stroke, ischemia-driven coronary revascularization, and hospitalization for unstable angina or heart failure) and death were jointly estimated, linked by a shared frailty accounting for patient risk heterogeneity and correlated within-patient nonfatal events. An association parameter also quantified the strength of the linkage between risk of nonfatal events and death. The model provides accurate relative estimates of nonfatal event risk if nonfatal events are associated with increased risk for death. With 3,064 first and 5,425 total events, 190 fewer first and 385 fewer total nonfatal cardiovascular events or deaths were observed with alirocumab compared with placebo. Alirocumab reduced total nonfatal cardiovascular events (hazard ratio: 0.87; 95% confidence interval: 0.82 to 0.93) and death (hazard ratio: 0.83; 95% confidence interval: 0.71 to 0.97) in the presence of a strong association between nonfatal and fatal event risk. In patients with ACS, the total number of nonfatal cardiovascular events and deaths prevented with alirocumab was twice the number of first events prevented. Consequently, total event reduction is a more comprehensive metric to capture the totality of alirocumab clinical efficacy after ACS
Psychosocial, socio-cultural, and environmental influences on mental health help-seeking among African-American men
http://dx.doi.org/10.1016/j.jomh.2012.03.00
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
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US Department of Energy Chernobyl Database
The Chernobyl Database project is developing and maintaining an information to provide researchers with data and resource materials relating to the Chernobyl nuclear accident of April 1986. The system is the official United States repository for Chernobyl data. The system includes a collection of Chernobyl-related documents, a database of bibliographic references, and a collection of radiological measurements records. In addition, projects have been developed to make the resources more accessible and easy to use. These products include a personal-computer-based bibliographic search system (ChernoLit{trademark}), two printed bibliographies, and a personal- computer-based radiological measurements database system (ChernoDat)
Patterns of discharge antiplatelet therapy and late outcomes among 8,582 patients with bleeding during acute coronary syndrome: A pooled analysis from PURSUIT, PARAGON-A, PARAGON-B, and SYNERGY
10.1016/j.ahj.2010.09.001American Heart Journal16061056-1064.e2AHJO
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