Accumulative risk of clinical event in high-risk radiologically isolated syndrome in Argentina: data from the nationwide registry RelevarEM

BackgroundST-elevation myocardial infarction (STEMI) occurs as a result of rupture of an atherosclerotic plaque in the coronary arteries. Limited data exist regarding the impact of culprit coronary vessel on hard clinical event rates. This study investigated the impact of culprit vessel on outcomes after primary percutaneous coronary intervention (PCI) of STEMI.MethodsA total of 29 832 previously cardiac healthy patients who underwent primary PCI between 2003 and 2014 were prospectively included from the Swedish Coronary Angiography and Angioplasty Registry and the Registry of Information and Knowledge about Swedish Heart Intensive care Admissions. Patients were stratified into three groups based on culprit vessel (right coronary artery (RCA), left anterior descending artery (LAD) and left circumflex artery (LCx)). The primary outcome was 1-year mortality. The secondary outcomes included 30-day and 5-year mortality, as well as heart failure, stroke, bleeding and myocardial reinfarction at 30 days, 1 year and 5 years. Univariable and multivariable analyses were done using Cox regression models.ResultsOne-year analyses revealed that LAD infarctions had the highest increased risk of death, heart failure and stroke compared with RCA infarctions, which had the lowest risk. Sensitivity analyses revealed that reduced left ventricular ejection fraction on discharge partially explained this increased relative risk in mortality. Furthermore, landmark analyses revealed that culprit vessel had no significant influence on 1-year mortality if a patient survived 30 days after myocardial infarction. Subgroup analyses revealed female sex and multivessel disease (MVD) as significant high-risk groups with respect to 1-year mortality.ConclusionsLAD and LCx infarctions had a relatively higher adjusted mortality rate compared with RCA infarctions, with LAD infarctions in particular being associated with an increased risk of heart failure, stroke and death. Culprit vessel had limited influence on mortality after 1 month. High-risk patient groups include LAD infarctions in women or with concomitant MVD.

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Cost-effectiveness Analysis of Sequential Treatment of Abaloparatide Followed by Alendronate Versus Teriparatide Followed by Alendronate in Postmenopausal Women With Osteoporosis in the United States

Annals of Pharmacotherapy ◽

10.1177/1060028018798034 ◽

2018 ◽

Vol 53 (2) ◽

pp. 134-143 ◽

Cited By ~ 9

Author(s):

Quang A. Le ◽

Joel W. Hay ◽

Russell Becker ◽

Yamei Wang

Keyword(s):

United States ◽

Health Care ◽

Cost Effectiveness ◽

High Risk ◽

The United States ◽

Clinical Event ◽

Risk Of Fracture ◽

Life Years ◽

The Us ◽

Des Model

Background: The US Food and Drug Administration has recently approved abaloparatide (ABL) for treatment of women with postmenopausal osteoporosis (PMO) at high risk of fracture. With increasing health care spending and drug prices, it is important to quantify the value of newly available treatment options for PMO. Objective: To determine cost-effectiveness of ABL compared with teriparatide (TPTD) for treatment of women with PMO in the United States. Methods: A discrete-event simulation (DES) model was developed to assess cost-effectiveness of ABL from the US health care perspective. The model included three 18-month treatment strategies with either placebo (PBO), TPTD, or ABL, all followed by additional 5-year treatment with alendronate (ALN). High-risk patients were defined as women with PMO ⩾65 years old with a prior vertebral fracture. Baseline clinical event rates, risk reductions, and patient characteristics were based on the Abaloparatide Comparator Trial in Vertebral Endpoints (ACTIVE) trial. Results: Over a 10-year period, the DES model yielded average total discounted per-patient costs of $10 212, $46 783, and $26 837 and quality-adjusted life-years (QALYs) of 6.742, 6.781, and 6.792 for PBO/ALN, TPTD/ALN, and ABL/ALN, respectively. Compared with TPTD/ALN, ABL/ALN accrued higher QALYs at lower cost and produced an incremental cost-effectiveness ratio (ICER) of $333 266/QALY relative to PBO/ALN. In high-risk women, ABL/ALN also had more QALYs and less cost over TPTD/ALN and yielded an ICER of $188 891/QALY relative to PBO/ALN. Conclusion and Relevance: ABL is a dominant treatment strategy over TPTD. In women with PMO at high risk of fracture, ABL is an alternative cost-effective treatment.

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Oligoclonal bands increase the specificity of MRI criteria to predict multiple sclerosis in children with radiologically isolated syndrome

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217319836664 ◽

2019 ◽

Vol 5 (1) ◽

pp. 205521731983666 ◽

Cited By ~ 10

Author(s):

Naila Makhani ◽

Christine Lebrun ◽

Aksel Siva ◽

Sona Narula ◽

Evangeline Wassmer ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Multiple Sclerosis ◽

Cerebrospinal Fluid ◽

Magnetic Resonance ◽

Diagnostic Criteria ◽

Clinical Event ◽

Oligoclonal Bands ◽

Resonance Imaging ◽

Diagnostic Indices ◽

Radiologically Isolated Syndrome

Background Steps towards the development of diagnostic criteria are needed for children with the radiologically isolated syndrome to identify children at risk of clinical demyelination. Objectives To evaluate the 2005 and 2016 MAGNIMS magnetic resonance imaging criteria for dissemination in space for multiple sclerosis, both alone and with oligoclonal bands in cerebrospinal fluid added, as predictors of a first clinical event consistent with central nervous system demyelination in children with radiologically isolated syndrome. Methods We analysed an international historical cohort of 61 children with radiologically isolated syndrome (≤18 years), defined using the 2010 magnetic resonance imaging dissemination in space criteria (Ped-RIS) who were followed longitudinally (mean 4.2 ± 4.7 years). All index scans also met the 2017 magnetic resonance imaging dissemination in space criteria. Results Diagnostic indices (95% confidence intervals) for the 2005 dissemination in space criteria, with and without oligoclonal bands, were: sensitivity 66.7% (38.4–88.2%) versus 72.7% (49.8–89.3%); specificity 83.3% (58.6–96.4%) versus 53.9% (37.2–69.9%). For the 2016 MAGNIMS dissemination in space criteria diagnostic indices were: sensitivity 76.5% (50.1–93.2%) versus 100% (84.6–100%); specificity 72.7% (49.8–89.3%) versus 25.6% (13.0–42.1%). Conclusions Oligoclonal bands increased the specificity of magnetic resonance imaging criteria in children with Ped-RIS. Clinicians should consider testing cerebrospinal fluid to improve diagnostic certainty. There is rationale to include cerebrospinal fluid analysis for biomarkers including oligoclonal bands in planned prospective studies to develop optimal diagnostic criteria for radiologically isolated syndrome in children.

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Radiologically isolated syndrome in children

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000395 ◽

2017 ◽

Vol 4 (6) ◽

pp. e395 ◽

Cited By ~ 21

Author(s):

Naila Makhani ◽

Christine Lebrun ◽

Aksel Siva ◽

David Brassat ◽

Clarisse Carra Dallière ◽

...

Keyword(s):

Spinal Cord ◽

Demyelinating Disease ◽

Clinical Symptoms ◽

Clinical Event ◽

Oligoclonal Bands ◽

Spinal Cord Lesions ◽

Historical Cohort ◽

Radiologically Isolated Syndrome ◽

Increased Risk ◽

Cns Demyelination

Objective:To describe clinical and radiologic outcomes of children with incidental findings on neuroimaging suggestive of CNS demyelination (termed “radiologically isolated syndrome” or RIS).Methods:Clinical and radiologic data were obtained from a historical cohort of children with no symptoms of demyelinating disease who had MRI scans that met the 2010 MRI criteria for dissemination in space for MS.Results:We identified 38 children (27 girls and 11 boys) with RIS now being prospectively followed at 16 sites in 6 countries. The mean follow-up time was 4.8 ± 5.3 years. The most common reason for initial neuroimaging was headache (20/38, 53%). A first clinical event consistent with CNS demyelination occurred in 16/38 children (42%; 95% confidence interval [CI]: 27%–60%) in a median of 2.0 years (interquartile range [IQR] 1.0–4.3 years). Radiologic evolution developed in 23/38 children (61%; 95% CI: 44%–76%) in a median of 1.1 years (IQR 0.5–1.9 years). The presence of ≥2 unique oligoclonal bands in CSF (hazard ratio [HR] 10.9, 95% CI: 1.4–86.2, p = 0.02) and spinal cord lesions on MRI (HR 7.8, 95% CI: 1.4–43.6, p = 0.02) were associated with an increased risk of a first clinical event after adjustment for age and sex.Conclusions:We describe the clinical characteristics and outcomes of children with incidental MRI findings highly suggestive of CNS demyelination. Children with RIS had a substantial risk of subsequent clinical symptoms and/or radiologic evolution. The presence of oligoclonal bands in CSF and spinal cord lesions on MRI were associated with an increased risk of a first clinical event.

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Abstract 13163: Clinical Impact of Contralateral Carotid Occlusion During Carotid Intervention in Contemporary Practice: An Analysis of the National Cardiovascular Data Registry Peripheral Vascular Intervention Registry

Circulation ◽

10.1161/circ.142.suppl_3.13163 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Anna K Krawisz ◽

Kenneth Rosenfield ◽

Christopher J White ◽

Michael R Jaff ◽

Joseph Campbell ◽

...

Keyword(s):

High Risk ◽

Clinical Impact ◽

Adverse Outcomes ◽

Carotid Occlusion ◽

Hospital Death ◽

Vascular Intervention ◽

Carotid Revascularization ◽

Symptomatic Disease ◽

Nationwide Registry ◽

Increased Risk

Introduction: Contralateral carotid occlusion (CCO) is an established high-risk feature for carotid endarterectomy (CEA) and is a reason to recommend carotid artery stenting (CAS). Recent observational data have called into question whether CCO remains a high-risk feature for CEA. We investigated the clinical impact of CCO among patients undergoing CEA and CAS in a contemporary nationwide registry. Hypothesis: CCO confers an elevated risk of in-hospital adverse events among patients undergoing CEA, but not CAS. Methods: All patients undergoing CEA or CAS from 2005-2019 in the NCDR CARE and PVI registries were included. The primary exposure was the presence of a CCO. The outcome was a composite of in-hospital death, stroke, and myocardial infarction. Analyses were stratified by treatment with CEA or CAS. Multivariable logistic regression models were used to identify factors associated with adverse outcomes. Results: Among 58,423 patients, 4,624 (7.9%) patients had a CCO. Of those, 68.9% (N=3,185) underwent CAS and 31.1% (N=1,439) underwent CEA. The average age of patients with CCO was 69.5±9.7, 32.6% were female, 92.8% were Caucasian, 51.7% had a prior TIA or stroke, and 45.4% had symptomatic disease. Over the study period, there was a 4.3% decline in procedures performed on patients with CCO (p <0.001), but CAS remained the primary revascularization strategy (7.8% CAS vs 3.5% CEA in 2019Q2). Unadjusted rates of the composite outcome were lower after CAS (3.2%) than after CEA (3.9%). Following adjustment, CCO was associated with a 60% increase in odds of an adverse outcome after CEA (95%CI 1.2-2.12, p=0.0013) (Figure). There was no increase in risk for patients treated with CAS (adjusted OR 0.99, 95%CI 0.79-1.22, p=0.89). Conclusions: In this contemporary nationwide registry analysis, CCO remains an important predictor of increased risk in patients undergoing CEA, but not CAS. These data support the continued use of CCO to guide carotid revascularization strategy.

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Lithium is associated with decrease in all-cause and suicide mortality in high-risk bipolar patients: A nationwide registry-based prospective cohort study

Journal of Affective Disorders ◽

10.1016/j.jad.2015.04.055 ◽

2015 ◽

Vol 183 ◽

pp. 159-165 ◽

Cited By ~ 32

Author(s):

Elena Toffol ◽

Taina Hätönen ◽

Antti Tanskanen ◽

Jouko Lönnqvist ◽

Kristian Wahlbeck ◽

...

Keyword(s):

Cohort Study ◽

High Risk ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Suicide Mortality ◽

Nationwide Registry ◽

Bipolar Patients

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Impact of pregnancy on conversion to clinically isolated syndrome in a radiologically isolated syndrome cohort

Multiple Sclerosis Journal ◽

10.1177/1352458511435931 ◽

2012 ◽

Vol 18 (9) ◽

pp. 1297-1302 ◽

Cited By ~ 40

Author(s):

C Lebrun ◽

E Le Page ◽

O Kantarci ◽

A Siva ◽

D Pelletier ◽

...

Keyword(s):

Post Partum ◽

Brain Mri ◽

Clinical Event ◽

Absolute Difference ◽

Control Group ◽

Prospective Longitudinal Study ◽

Radiologically Isolated Syndrome ◽

Neurological Event ◽

Prospective Longitudinal ◽

The Impact

Background: In multiple sclerosis (MS), the relapse rate declines during pregnancy and increases during the first three months post-partum before returning to the pre-pregnancy rate. It is unknown whether pregnancy impacts the risk of clinical conversion in those within the presymptomatic period. Objectives: We investigate the impact of pregnancy on developing a clinical event in women diagnosed with radiologically isolated syndrome (RIS). Methods: All women with RIS underwent clinical and radiological assessments as part of an observational, prospective, longitudinal study. Clinical and MRI outcomes were analyzed during and after pregnancy. Subjects who became pregnant were compared with an age-matched female RIS group who did not become pregnant during the same follow-up period. Results: A total of 60 women with RIS were followed for up to seven years. Among them, seven became pregnant and were compared with 53 age-matched control women with RIS who did not become pregnant during the observation period. A significantly shorter time of conversion to the first neurological event was observed in the pregnant group [15.3 months (10–18)] compared with the non-pregnant controls [35.7 months (8–76)], yielding an absolute difference of 20.4 months ( p<0.05). The mean (SD) number of active lesions on a subsequent brain MRI scan was significantly higher in the pregnant group [3.2 (±1.7)] compared with the control group [1.8 (±0.6)]. Conclusions: The risk for clinical conversion from RIS to a clinical event and new MRI disease activity seems to be influenced by pregnancy. Pregnancy related physiological changes could operate as early as the presymptomatic period in patients with MS.

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