1,721,077 research outputs found
Procedural Strategies to Reduce the Incidence of Contrast-Induced Acute Kidney Injury During Percutaneous Coronary Intervention
No full textContrast-induced acute kidney injury (CI-AKI) is a potentially serious complication following coronary angiography and percutaneous coronary intervention (PCI). The incidence of CI-AKI is particularly high in patients with advanced chronic kidney disease (defined as an estimated glomerular filtration rate <30 ml/min/1.73 m2). Although much effort has been dedicated to the identification and implementation of preventive measures for this complication at the pre-intervention stage, much less has been investigated on the procedural strategies and techniques to decrease the risk of CI-AKI during PCI. The mainstay of such approaches relies on the minimization of contrast volume by means of specific strategies or dedicated devices. Invasive imaging, such as intravascular ultrasound or non-contrast-based optical coherence tomography, is another pillar of any ultra-low-contrast-volume PCI protocol. Finally, an array of miscellaneous ancillary measures can be implemented to decrease the risk of CI-AKI, which includes the use of radial access, remote ischemic conditioning, and hemodynamic support in high-risk patients. The present review analyzes the technical aspects as well as the scientific evidence supporting these novel techniques, with the goal to improve the outcomes of patients at high risk for CI-AKI undergoing PCI
Impact of Left Ventricular End-Diastolic Pressure on the Outcomes of Patients Undergoing Percutaneous Coronary Intervention
No full textLeft ventricular end-diastolic pressure (LVEDP) is an important hemodynamic marker of left ventricular performance and affects coronary perfusion. We evaluated the association of LVEDP with patient outcomes after elective or urgent percutaneous coronary intervention (PCI). We included n = 49,600 patients undergoing elective or urgent PCI. Patients were divided according to LVEDP tertile for descriptive analysis. The primary end point was in-hospital mortality. A recursive partitioning tree model for mortality was built to guide decision-making in patients with high LVEDP undergoing nonemergent PCI. Overall, n = 18,099 patients had an LVEDP 18 mm Hg. Patients in the high LVEDP tertile had a worse clinical and angiographic/procedural profile and experienced a higher incidence of in-hospital post-PCI adverse outcomes, including death (LVEDP 18 mm Hg 0.8%, p..
Can our choice of contrast media impact renal and cardiovascular outcomes?
No full textPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/117550/1/ccd26483.pd
Using Propensity Score Matching in Clinical Investigations: A Discussion and Illustration
Full text linkPropensity 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
The human bovine arch—a common misnomer
Full text linkNo abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56092/1/21086_ftp.pd
Does gadolinium-based angiography protect against contrast-induced nephropathy?: A systematic review of the literature
Full text linkWe evaluated the incidence of contrast-induced nephropathy (CIN) in patients exposed to gadolinium for diagnostic or therapeutic procedures. Background: CIN with iodinated contrast agents is a leading cause of acute renal failure. Gadolinium is often used as an alternative to iodinated contrast in patients at increased risk of CIN. The safety of gadolinium in patients at increased risk of CIN has not been established. Methods and Results: The authors performed a systematic review by searching MEDLINE, ISI Web of Knowledge, Current Contents, Embase, and the Cochrane Central Register of Controlled Trials to identify relevant studies evaluating gadolinium and its associated incidence of CIN. They identified 17 studies that reported both favorable and negative results with regard to the association of gadolinium and CIN. The differences in the results appeared to be dose related. When gadolinium was used in doses of 0.4 mmol/kg or higher, there appeared to be an increased incidence of ARF particularly in patients with preexisting renal insufficiency. Conclusions: Although the evidence base is limited, gadolinium does not appear to be safer than iodinated contrast in patients at risk of CIN. Given the lack of randomized data to support its safety, gadolinium in lieu of iso-osmolar iodinated contrast cannot be advocated in patients at high risk of contrast nephropathy. © 2008 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/58087/1/21459_ftp.pd
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
A data driven approach for optimizing cardiac care: Acute coronary syndromes and beyond
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