Acute myocardial infarction in pregnancy: Complex challenges in clinical - decision making for the mother and fetus

Abstract Serial laboratory determinations are now routinely performed on patients admitted to intensive-care units. Adequate interpretation of such cumulative information for clinical decision-making purposes is a challenging problem. We describe a statistical method for predicting--sequentially as the data become available--the patient's outcome, death or survival. Thus, the method goes beyond previously reported techniques that base such prediction on only a single multivariate observation. The method has been applied to daily measurements of serum urea and lactate dehydrogenase, performed during one week on patients hospitalized in the coronary-care unit with acute myocardial infarction. Two baseline variables were also included in the dynamic risk index so derived: the age of the patient and the number of previous myocardial infarctions recorded on admission. We also discuss the problems of selecting the most-predictive laboratory tests and of determining for each test the amount of past data needed to achieve satisfactory prediction. We distinguish between global evaluation of the dynamic risk index obtained (in terms of specificity and sensitivity) and individual interpretation (in terms of posterior/prior probability ratio) of a given risk score for a particular patient. The approach described may contribute to more effective use of results of repeated laboratory tests on critically ill patients.

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Use of an Artificial Neural Network for Data Analysis in Clinical Decision-Making: The Diagnosis of Acute Coronary Occlusion

Neural Computation ◽

10.1162/neco.1990.2.4.480 ◽

1990 ◽

Vol 2 (4) ◽

pp. 480-489 ◽

Cited By ~ 176

Author(s):

William G. Baxt

Keyword(s):

Neural Network ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Artificial Neural Network ◽

Coronary Occlusion ◽

Clinical Decision Making ◽

Clinical Decision ◽

Acute Coronary Occlusion ◽

Artificial Neural ◽

Better Than

A nonlinear artificial neural network trained by backpropagation was applied to the diagnosis of acute myocardial infarction (coronary occlusion) in patients presenting to the emergency department with acute anterior chest pain. Three-hundred and fifty-six patients were retrospectively studied, of which 236 did not have acute myocardial infarction and 120 did have infarction. The network was trained on a randomly chosen set of half of the patients who had not sustained acute myocardial infarction and half of the patients who had sustained infarction. It was then tested on a set consisting of the remaining patients to which it had not been exposed. The network correctly identified 92% of the patients with acute myocardial infarction and 96% of the patients without infarction. When all patients with the electrocardiographic evidence of infarction were removed from the cohort, the network correctly identified 80% of the patients with infarction. This is substantially better than the performance reported for either physicians or any other analytical approach.

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The role of continuous glucose monitoring in clinical decision-making in diabetes in pregnancy

Australian and New Zealand Journal of Obstetrics and Gynaecology ◽

10.1111/j.1479-828x.2007.00716.x ◽

2007 ◽

Vol 47 (3) ◽

pp. 186-190 ◽

Cited By ~ 46

Author(s):

Kylie McLACHLAN ◽

Alicia JENKINS ◽

David O?NEAL

Keyword(s):

Decision Making ◽

Continuous Glucose Monitoring ◽

Clinical Decision Making ◽

Glucose Monitoring ◽

Clinical Decision ◽

Diabetes In Pregnancy ◽

In Pregnancy

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Pharmacotherapy for acute myocardial infarction

Journal of Korean Medical Association ◽

10.5124/jkma.2021.64.2.139 ◽

2021 ◽

Vol 64 (2) ◽

pp. 139-151

Author(s):

Sung Soo Kim ◽

Hyun Kuk Kim

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Randomized Controlled Trials ◽

Clinical Decision Making ◽

Heart Association ◽

Coronary Intervention ◽

Clinical Decision ◽

Controlled Trials ◽

Randomized Controlled ◽

Consensus Document

Clinical practice guidelines published by the European Society of Cardiology and the American College of Cardiology/ American Heart Association provide recommendations based on evidence, including randomized controlled trials and registry data, for clinicians to enable efficient clinical decision-making and improve prognosis for patients with acute myocardial infarction (AMI). However, there are several differences in practice, health systems, and races between Korea and Western countries; further, many studies on pharmacotherapy were conducted in the prepercutaneous coronary intervention era. An expert consensus document on pharmacotherapy for AMI was recently published following demands for the establishment of Korean guideline reflecting data in the modern percutaneous coronary intervention era. In this review, we summarized AMI guidelines from Europe, America, Japan, and Korea, and analyzed studies on pharmacotherapy for AMI including well-organized randomized controlled trials by Korean researchers and large-sized registry datasets, such as the Korea Acute Myocardial Infarction Registry and the Korean National Health Insurance Service.

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Granulomatosis with polyangiitis and pregnancy: A case report and review of the literature

Obstetric Medicine ◽

10.1177/1753495x18822581 ◽

2019 ◽

Vol 13 (2) ◽

pp. 76-82

Author(s):

A Daher ◽

G Sauvetre ◽

N Girszyn ◽

E Verspyck ◽

H Levesque ◽

...

Keyword(s):

Decision Making ◽

Granulomatosis With Polyangiitis ◽

Clinical Decision Making ◽

Clinical Decision ◽

Intravenous Immunoglobulins ◽

Review Of The Literature ◽

Healthy Male ◽

Sudden Loss ◽

Loss Of Hearing ◽

In Pregnancy

The association of granulomatosis with polyangiitis and pregnancy is rare and therapeutic options are limited by the risk of teratogenicity and fetotoxicity. There is a paucity of published literature to guide clinical decision-making in these cases. We report the case of a 26-year-old woman with no medical history who presented at 21 weeks of gestation with a bilateral sudden loss of hearing and erosive rhinitis. The diagnosis of granulomatosis with polyangiitis was confirmed radiologically and biologically. Corticosteroids were not enough to stabilize the disease and she received intravenous immunoglobulins with remission. A successful delivery of a healthy male newborn was done at 36 weeks. A review of all published literature on granulomatosis with polyangiitis in pregnancy between 1970 and 2017 is presented. Trial registration: Not applicable.

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