Diagnostic accuracy of high-definition CT coronary angiography in high-risk patients

2016 ◽  
Vol 71 (2) ◽  
pp. 151-158 ◽  
Author(s):  
S.S. Iyengar ◽  
G. Morgan-Hughes ◽  
O. Ukoumunne ◽  
B. Clayton ◽  
E.J. Davies ◽  
...  
Keyword(s):  
High Risk ◽  
Coronary Angiography ◽  
Diagnostic Accuracy ◽  
Ct Coronary Angiography ◽  
High Definition ◽  
High Risk Patients ◽  
Risk Patients

Avoidance of Coronary Angiography in High-Risk Patients With Acute Coronary Syndromes: The ACSIS Registry Findings

2020 ◽  
Vol 21 (10) ◽  
pp. 1230-1236 ◽  
Author(s):  
Ronen Jaffe ◽  
Basheer Karkabi ◽  
Ilan Goldenberg ◽  
Nir Shlomo ◽  
Dina Vorobeichik ◽  
...  
Keyword(s):  
High Risk ◽  
Coronary Angiography ◽  
Acute Coronary Syndromes ◽  
High Risk Patients ◽  
Risk Patients ◽  
Coronary Syndromes

scholarly journals The Kaiser score reliably excludes malignancy in benign contrast-enhancing lesions classified as BI-RADS 4 on breast MRI high-risk screening exams

2020 ◽  
Vol 30 (11) ◽  
pp. 6052-6061 ◽  
Author(s):  
Ruxandra Iulia Milos ◽  
Francesca Pipan ◽  
Anastasia Kalovidouri ◽  
Paola Clauser ◽  
Panagiotis Kapetas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Diagnostic Accuracy ◽  
Breast Mri ◽  
Histopathological Diagnosis ◽  
Risk Screening ◽  
High Risk Patients ◽  
Risk Patients ◽  
Malignant Lesions ◽  
High Risk Screening

Abstract Objectives MRI is an integral part of breast cancer screening in high-risk patients. We investigated whether the application of the Kaiser score, a clinical decision-support tool, may be used to exclude malignancy in contrast-enhancing lesions classified as BI-RADS 4 on breast MRI screening exams. Methods This retrospective study included 183 consecutive, histologically proven, suspicious (MR BI-RADS 4) lesions detected within our local high-risk screening program. All lesions were evaluated according to the Kaiser score for breast MRI by three readers blinded to the final histopathological diagnosis. The Kaiser score ranges from 1 (lowest, cancer very unlikely) to 11 (highest, cancer very likely) and reflects increasing probabilities of malignancy, with scores greater than 4 requiring biopsy. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. Results There were 142 benign and 41 malignant lesions, diagnosed in 159 patients (mean age, 43.6 years). Median Kaiser scores ranged between 2 and 5 in benign and 7 and 8 in malignant lesions. For all lesions, the Kaiser score’s accuracy, represented by the area under the curve (AUC), ranged between 86.5 and 90.2. The sensitivity of the Kaiser score was high, between 95.1 and 97.6% for all lesions, and was best in mass lesions. Application of the Kaiser score threshold for malignancy (≤ 4) could have potentially avoided 64 (45.1%) to 103 (72.5%) unnecessary biopsies in 142 benign lesions previously classified as BI-RADS 4. Conclusions The use of Kaiser score in high-risk MRI screening reliably excludes malignancy in more than 45% of contrast-enhancing lesions classified as BI-RADS 4. Key Points • The Kaiser score shows high diagnostic accuracy in identifying malignancy in contrast-enhancing lesions in patients undergoing high-risk screening for breast cancer. • The application of the Kaiser score may avoid > 45% of unnecessary breast biopsies in high-risk patients. • The Kaiser score aids decision-making in high-risk breast cancer MRI screening programs.

scholarly journals Increased serum IL-6 is predictive of long-term cardiovascular events in high-risk patients submitted to coronary angiography: an observational study.

2021 ◽  
Author(s):  
Márcio Mossmann ◽  
Marco Vugman Wainstein ◽  
Stéfani Mariani ◽  
Guilherme Pinheiro Machado ◽  
Gustavo Neves Araujo ◽  
...  
Keyword(s):  
High Risk ◽  
Coronary Angiography ◽  
Observational Study ◽  
Cardiovascular Events ◽  
Primary Outcome ◽  
High Risk Patients ◽  
Long Term Follow Up ◽  
Risk Patients

Abstract BACKGROUND Interleukin-6 (IL-6) is an inflammation-related cytokine associated with an elevated risk of cardiovascular events. In a previous study, we demonstrated that increased IL-6 was predictive of sub-clinical atherosclerotic coronary disease in intermediate-risk patients undergoing coronary angiography. In the present study, we investigated whether increased serum IL-6 is predictive of cardiovascular events in high-risk patients. METHODS In this observational study, consecutive patients referred for elective coronary angiography due to stable chest pain/myocardial ischemia had IL-6 measured immediately before the procedure. Long-term follow-up was performed by phone call or e-mail, and their clinical registries were revised. The primary outcome was a composite of new myocardial infarction, new ischemic stroke, hospitalization due to heart failure, new coronary revascularization, cardiovascular death, and death due to all causes. RESULTS From the 141 selected patients, 100 completed the IL-6 analysis and were followed for a mean of 5.5 years. The median age was 61.1 years, 44% were men, and 61% had type-2 diabetes. The median overall time-to-event for the primary outcome was 297 weeks (95% confidence interval [CI] = 266.95–327.16). A receiver operator characteristic curve defined the best cut-off value of baseline serum IL-6 (0.44 pg/mL) with sensitivity (84.37%) and specificity (38.24%) to define two groups. High IL-6 level was moderately predictive of cardiovascular events. ( p for interaction = 0.015) (hazard ratio = 2.81; 95% CI = 1.38–5.72, p=0.01). The subgroup analysis did not find interactions between patients with or without diabetes, obesity, or hypertension. CONCLUSION This preliminary study indicates that, in high-risk symptomatic patients undergoing elective coronary angiography, increased pre-procedure serum levels of IL-6 predicted long-term cardiovascular outcomes. These results were similar irrespective of diabetes, hypertension, or obesity status. IL-6 must be studied in larger long-term follow-up studies as a potential tool to re-classify patients with increased cardiovascular risk.

Diagnostic Accuracy of Stop-Bang Questionnaire in Diagnosing High Risk Patients of Obstructive Sleep Apnea Considering Polysomnography as a Gold Standard

2021 ◽  
Vol 15 (10) ◽  
pp. 2823-2825
Author(s):  
Masood uz Zaman Babar ◽  
Rizwan Ali Tunio ◽  
Sunil Dat Maheshwari ◽  
Ali Hassan ◽  
Hasham Masood Qureshi
Keyword(s):  
Obstructive Sleep Apnea ◽  
Standard Deviation ◽  
Sleep Apnea ◽  
High Risk ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Gold Standard ◽  
High Risk Patients ◽  
Obstructive Sleep ◽  
Risk Patients

Objective: To determine the diagnostic accuracy of stop-bang questionnaire to diagnose high risk patients of obstructive sleep apnea taking polysomnography as gold standard. Methodology: This cross-sectional descriptive study was conducted at Isra University Hospital Hyderabad and help taken from Sleep Disorder Laboratory, The Aga Khan Hospital, Karachi. Patients with age of 18 to 70 years, presenting with symptoms of OSA of either gender were included. History was taken from patients. STOP- BANG Questionnaire was filled out for each patient consenting to participate in the study. All information was noted and entered in the Proforma. Results: Mean age of patients was 40.1 with standard deviation 17.6, mean AHI score was 20 with standard deviation 6 and stop bang score showed average 6.8 with standard deviation 2.7. Distribution of gender showed that most of the patients were male. Diagnostic accuracy calculated for stop bang questionnaire, sensitivity 77.2%, Specificity 65.5%, Positive Predictive Value 75.4%, Negative Predictive Value 67.8%, Diagnostic Accuracy 72.3% of stop bang questionnaire as follows. Conclusion: This study confirms the STOP-Bang questionnaire's high performance in screening for Obstructive sleep apnea (OSA) in the surgical population and sleep clinic. The likelihood of OSA severity increases from moderate to severe with the increasing STOP-Bang score. Keywords: Obstructive sleep apnea, stop-bang questionnaire, apnea-hypopnea index, polysomnogram

scholarly journals Which Out-of-Hospital Cardiac Arrest Patients without ST-Segment Elevation Benefit from Early Coronary Angiography? Results from the Korean Hypothermia Network Prospective Registry

2021 ◽  
Vol 10 (3) ◽  
pp. 439
Author(s):  
Hwan Song ◽  
Hyo Kim ◽  
Kyu Park ◽  
Soo Kim ◽  
Won Kim ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Coronary Angiography ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
High Risk Patients ◽  
Neurologic Outcomes ◽  
Risk Patients ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest

The effect of early coronary angiography (CAG) in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation (STE) is still controversial. It is not known which subgroups of patients without STE are the most likely to benefit. The objective of this study was to evaluate the association between emergency CAG and neurologic outcomes and identify subgroups with improved outcomes when emergency CAG was performed. This prospective, multicenter, observational cohort study was based on data from the Korean Hypothermia Network prospective registry (KORHN-PRO) 1.0. Adult OHCA patients who were treated with targeted temperature management (TTM) without any obvious extracardiac cause were included. Patients were dichotomized into early CAG (≤24 h) and no early CAG (>24 h or not performed) groups. High-risk patients were defined as having the Global Registry of Acute Coronary Events (GRACE) score > 140, time from collapse to return of spontaneous circulation (ROSC) > 30 min, lactate level > 7.0 mmol/L, arterial pH < 7.2, cardiac enzyme elevation and ST deviation. The primary outcome was good neurologic outcome at 6 months after OHCA. Of the 1373 patients from the KORHN-PRO 1.0 database, 678 patients met the inclusion criteria. The early CAG group showed better neurologic outcomes at 6 months after cardiac arrest (CA) (adjusted odds ratio: 2.21 (1.27–3.87), p = 0.005). This was maintained even after propensity score matching (adjusted odds ratio: 2.23 (1.39–3.58), p < 0.001). In the subgroup analysis, high-risk patients showed a greater benefit from early CAG. In contrast, no significant association was found in low-risk patients. Early CAG was associated with good neurologic outcome at 6 months after CA and should be considered in high-risk patients.

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