Coronary Artery Disease: Spertus J

Thomas RJ, King M, Lui K, Oldridge N, Piña IL, Spertus J, Anonymous00090. · No affiliation provided · J Cardiopulm Rehabil Prev. · Pubmed #17885506 No free full text.

This publication has no abstract.

Spertus J. · No affiliation provided · Am Heart J. · Pubmed #11685157 No free full text.

This publication has no abstract.

Singh M, Rihal CS, Roger VL, Lennon RJ, Spertus J, Jahangir A, Holmes DR. · Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. · Heart. · Pubmed #17923464 No free full text.

Abstract: OBJECTIVE: To evaluate whether adding comorbid conditions to a risk model can help predict in-hospital outcome and long-term mortality after percutaneous coronary intervention (PCI). DESIGN: Retrospective chart review SETTING: Academic medical centre. PATIENTS: 7659 patients who had 9032 PCIs. INTERVENTIONS: PCI performed at Mayo Clinic between 1 January 1999 and 30 June 2004. MAIN OUTCOME MEASURES: The Mayo Clinic Risk Score (MCRS) and the coronary artery disease (CAD)-specific index for determination of comorbid conditions in all patients. RESULTS: The mean (SD) MCRS score was 6.5 (2.9). The CAD-specific index was 0 or 1 in 46%, 2 or 3 in 30% and 4 or higher in 24%. The rate of in-hospital major adverse cardiovascular events (MACE) increased with higher MCRS and CAD-specific index (Cochran-Armitage test, p<0.001 for both models). The c-statistic for the MCRS for in-hospital MACE was 0.78; adding the CAD-specific index did not improve its discriminatory ability for in-hospital MACE (c-statistic = 0.78; likelihood ratio test, p = 0.29). A total of 707 deaths after dismissal occurred after 7253 successful procedures. The c-statistic for all-cause mortality was 0.69 for the MCRS model alone and 0.75 for the MCRS and CAD-specific indices together (likelihood ratio test, p<0.001), indicating significant improvement in the discriminatory ability. CONCLUSIONS: Addition of comorbid conditions to the MCRS adds significant prognostic information for post-dismissal mortality but adds little prognostic information about in-hospital complications after PCI. Such health-status measures should be included in future risk stratification models that predict long-term mortality after PCI.

Singh M, Rihal CS, Lennon RJ, Spertus J, Rumsfeld JS, Holmes DR. · Division of Cardiovascular Diseases, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. · Mayo Clin Proc. · Pubmed #17550750 links to  free full text

Abstract: OBJECTIVE: To derive risk models for percutaneous coronary intervention (PCI) outcomes from clinical and laboratory variables available before the procedure so they can be used for preprocedure risk stratification. PATIENTS AND METHODS: Using the Mayo Clinic registry, we analyzed 9035 PCIs on 7640 unique patients from January 1, 2000, through April 30, 2005. We included only the first PCI per patient (n=7457). Logistic regression was used to model the calculated risk score and major procedural complications. Separate risk models were made for mortality and major adverse cardiovascular events (MACE) derived solely from baseline and laboratory characteristics. Final risk scores for procedural death, defined as any death during the index hospitalization, and MACE contained the same 7 variables (age, myocardial infarction less than or equal to 24 hours, preprocedural shock, serum creatinine level, left ventricular ejection fraction, congestive heart failure, and peripheral artery disease). RESULTS: Models had adequate goodness of fit, and areas under the receiver operating characteristic curve were 0.74 and 0.89 for MACE and procedural death, respectively, indicating excellent overall discrimination. The model was robust across many subgroups, including those undergoing elective PCI, those having diabetes mellitus, and elderly patients. Bootstrap analysis indicated that the model was not overfit to the available data set. CONCLUSION: Before coronary angiography is performed, a risk-scoring system based on 7 variables can be used conveniently to predict cardiovascular complications after PCI. This model may be useful for providing patients with individualized, evidence-based estimates of procedural risk as part of the informed consent process.

Weintraub WS, Barnett P, Chen S, Hartigan P, Casperson P, O'Rourke R, Boden WE, Lewis C, Veledar E, Becker E, Culler S, Kolm P, Mahoney EM, Dunbar SB, Deaton C, O'Brien B, Goeree R, Blackhouse G, Nease R, Spertus J, Kaufman S, Teo K. · Atlanta VA Medical Center, Decatur, GA, USA. · Am Heart J. · Pubmed #16781215 No free full text.

Abstract: Percutaneous coronary intervention (PCI) remains a major therapeutic option for the treatment of chronic coronary artery disease. In the COURAGE trial, 2287 patients with chronic coronary disease were randomized between PCI with medical management and medical management alone. Embedded within the COURAGE trial is a detailed economic analysis being conducted in three health care systems: the US Veterans Administration (VA), Canada, and the US non-VA. Resource use and costs are being collected for each system and overall. Survival is assessed internally in the trial with mean follow-up of 4.5 years. Long-term mean survival will be estimated by projecting survival beyond the trial period by extrapolating the in-trial hazard rates. Utility is being assessed at baseline and at 1, 3, and 6 months and annually thereafter, using a computer-administered standard gamble. Quality-adjusted life years are calculated by multiplying survival by utility. The incremental cost-effectiveness ratio of PCI will be defined as the additional cost of PCI divided by the gain in life years and quality-adjusted life years. The 95% confidence regions of efficacy and costs will be determined by bootstrap over a range of acceptability thresholds, which will then be displayed in the cost-effectiveness plane and as a cost-effectiveness acceptability curve. A multilevel regression model will assess cost-effectiveness from a net benefit perspective. These approaches should provide the most detailed assessment available of the cost-effectiveness of PCI for coronary artery disease.

Kettelkamp R, House J, Garg M, Stuart RS, Grantham A, Spertus J. · Mid America Heart Institute, 5th Floor, Saint Luke's Hospital and the University of Missouri-Kansas City, 4100 Wornall Road, Kansas City, MO 64111, USA. · Circulation. · Pubmed #15364838 links to  free full text

Abstract: BACKGROUND: Coronary artery bypass graft (CABG) and percutaneous coronary revascularization (PCI) are strategies for treating coronary disease. Because the principal limitation of PCI is restenosis, CABG might be favored for those at high risk for restenosis. Using a clinical risk score for predicting restenosis, we examined whether patients with higher risks for restenosis were preferentially referred for CABG. METHODS AND RESULTS: A procedural registry of 2320 revascularization patients from whom data on procedure type, demographics, comorbid conditions, health status, vessel anatomy, and outcomes were taken was analyzed. Patients were classified and scored into 3 categories of restenosis risk ranging from 11% to 44%, as defined by 8 preprocedural characteristics. The objective of this study was to describe referral patterns between PCI and CABG in each category of risk. 2060 patients underwent nonemergent revascularization. 1404 of the patients underwent PCI and 656 were treated with CABG. Among the patients at low and intermediate risk for restenosis, twice as many were referred to PCI. Among those at the highest risk, 3-times as many were referred to PCI, resulting in a significant trend for those with the higher risks of restenosis to be preferentially referred to PCI (P=0.015). Similar results were seen when the analysis was restricted to only those with multivessel disease. CONCLUSIONS: Patients at higher risk for restenosis were being preferentially treated with PCI as opposed to CABG. These results may have implications for reevaluating current patterns of triaging patients between PCI and CABG, and for the use of drug-eluting stents within PCI patients.

Poston WS, Haddock CK, Conard MW, Jones P, Spertus J. · Mid America Heart Institute, University of Missouri-Kansas City, USA. · Behav Modif. · Pubmed #12587258 No free full text.

Abstract: Depression is a well-established risk factor for cardiovascular disease-related morbidity and mortality. It is common to screen for depression in patients undergoing coronary revascularization prior to revascularization; however, the validity of this assessment is unclear as some patients may experience transient, reactive depression rather than persistent depression. The authors evaluated whether an initial or 1-month postprocedure screen was optimal for identifying consistently depressed patients. Depression at 1-month postprocedure was a stronger predictor of depression at months 2 to 6 than baseline depression. After adjusting potential confounding variables, there was a much stronger relationship between 1-month and 6-month depression status (OR = 28.7 if depressed at 1 month, p < .001) than between baseline and 6-month depression status (OR = 6.5 if depressed at baseline, p < .001). Screening for depression at the time of revascularization is not as predictive of depression at 6 months as it is 1 month postprocedure.