Impact of morphine use on mortality in STEMI patients treated with primary PCI - preliminary data from a new registry

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
D Szabo ◽  
A Szabo ◽  
IF Edes ◽  
D Becker ◽  
B Merkely ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Survival Data ◽  
Preliminary Data ◽  
Laboratory Data ◽  
Rank Test ◽  
Primary Pci ◽  
Kaplan Meier ◽  
P2y12 Antagonists ◽  
Current Guidelines

Abstract Funding Acknowledgements Type of funding sources: None. Background Opioids decrease the effect of P2Y12 receptor inhibitors in vitro and observational reports suggest that morphine use is associated with larger infarct size. Our research group presented previously, using a prospective single-center registry, that periprocedural morphine use may have no impact on long-term mortality in STEMI patients treated with primary PCI and clopidogrel. Purpose Our purpose is to check this interaction using a new registry of patients treated according to the current guidelines, including novel antiplatelet agents. Methods From May until November 2020, we collected 196 STEMI patients treated with primary PCI. 88 (44.9%) of them got morphine during the prehospital and periprocedural care. Baseline demographic, anamnestic, procedural, and laboratory data were collected. Survival data were analysed using Kaplan-Meier survival curves and the log-rank test. To adjust for confounding, a 1:1 propensity score-matching analysis was performed using 114 cases. Results An adequate balance on baseline covariates was achieved during propensity score-matching. Kaplan-Meier analysis showed no difference in 30-days mortality of the patients treated with or without morphine neither in the original nor in the propensity score-matched population (p = 0.094 and p = 0.309, respectively). Conclusion Our preliminary data suggest that morphine may have no impact on mortality in STEMI patients treated with primary PCI and medical therapy according to the current guidelines including novel P2Y12 antagonists. Abstract Figure. Kaplan-Meier curves

scholarly journals Laparoscopic right posterior sectionectomy versus laparoscopic right hemihepatectomy for hepatocellular carcinoma in posterior segments: Propensity Score Matching Analysis

2018 ◽  
Vol 108 (1) ◽  
pp. 23-29
Author(s):  
J. Rhu ◽  
G. S. Choi ◽  
J. M. Kim ◽  
C. H. D. Kwon ◽  
S. J. Kim ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Disease Free Survival ◽  
Rank Test ◽  
Free Survival ◽  
Right Hemihepatectomy ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Right Posterior Sectionectomy

Background and Aims: This study was designed to analyze the feasibility of laparoscopic right posterior sectionectomy compared to laparoscopic right hemihepatectomy in patients with hepatocellular carcinoma located in the posterior segments. Material and Methods: The study included patients who underwent either laparoscopic right posterior sectionectomy or laparoscopic right hemihepatectomy for hepatocellular carcinoma located in segment 6 or 7 from January 2009 to December 2016 at Samsung Medical Center. After 1:1 propensity score matching, patient baseline characteristics and operative and postoperative outcomes were compared between the two groups. Disease-free survival and overall survival were compared using Kaplan–Meier log-rank test. Results: Among 61 patients with laparoscopic right posterior sectionectomy and 37 patients with laparoscopic right hemihepatectomy, 30 patients from each group were analyzed after propensity score matching. After matching, baseline characteristics of the two groups were similar including tumor size (3.4 ± 1.2 cm in laparoscopic right posterior sectionectomy vs 3.7 ± 2.1 cm in laparoscopic right hemihepatectomy, P = 0.483); differences were significant before matching (3.1 ± 1.3 cm in laparoscopic right posterior sectionectomy vs 4.3 ± 2.7 cm in laparoscopic right hemihepatectomy, P = 0.035). No significant differences were observed in operative and postoperative data except for free margin size (1.04 ± 0.71 cm in laparoscopic right posterior sectionectomy vs 2.95 ± 1.75 cm in laparoscopic right hemihepatectomy, P < 0.001). Disease-free survival (5-year survival: 38.0% in laparoscopic right posterior sectionectomy vs 47.0% in laparoscopic right hemihepatectomy, P = 0.510) and overall survival (5-year survival: 92.7% in laparoscopic right posterior sectionectomy vs 89.6% in laparoscopic right hemihepatectomy, P = 0.593) did not differ between the groups based on Kaplan–Meier log-rank test. Conclusion: For hepatocellular carcinoma in the posterior segments, laparoscopic right posterior sectionectomy was feasible compared to laparoscopic right hemihepatectomy when performed by experienced laparoscopic surgeons.

scholarly journals Higher Mortality of Ischaemic Stroke Patients Hospitalized with COVID-19 Compared to Historical Controls

2021 ◽  
pp. 1-6
Author(s):  
Stephanie L. Harrison ◽  
Elnara Fazio-Eynullayeva ◽  
Deirdre A. Lane ◽  
Paula Underhill ◽  
Gregory Y.H. Lip
Keyword(s):  
Propensity Score ◽  
Ischaemic Stroke ◽  
Propensity Score Matching ◽  
Rank Test ◽  
Chronic Obstructive ◽  
Healthcare Organizations ◽  
Stroke Patients ◽  
Obstructive Pulmonary Disease ◽  
Kaplan Meier ◽  
Historical Controls

<b><i>Introduction:</i></b> Increasing evidence suggests patients with coronavirus disease 2019 (COVID-19) may develop thrombosis and thrombosis-related complications. Some previous evidence has suggested COVID-19-associated strokes are more severe with worse outcomes for patients, but further studies are needed to confirm these findings. The aim of this study was to determine the association between COVID-19 and mortality for patients with ischaemic stroke in a large multicentre study. <b><i>Methods:</i></b> A retrospective cohort study was conducted using electronic medical records of inpatients from 50 healthcare organizations, predominately from the USA. Patients with ischaemic stroke within 30 days of COVID-19 were identified. COVID-19 was determined from diagnosis codes or a positive test result identified with CO­VID-19-specific laboratory codes between January 20, 2020, and October 1, 2020. Historical controls with ischaemic stroke without COVID-19 were identified in the period January 20, 2019, to October 1, 2019. 1:1 propensity score matching was used to balance the cohorts with and without CO­VID-19 on characteristics including age, sex, race and comorbidities. Kaplan-Meier survival curves for all-cause 60-day mortality by COVID-19 status were produced. <b><i>Results:</i></b> During the study period, there were 954 inpatients with ischaemic stroke and COVID-19. During the same time period in 2019, there were 48,363 inpatients with ischaemic stroke without COVID-19 (historical controls). Compared to patients with ischaemic stroke without COVID-19, patients with ischaemic stroke and COVID-19 had a lower mean age, had a lower prevalence of white patients, a higher prevalence of black or African American patients and a higher prevalence of hypertension, previous cerebrovascular disease, diabetes mellitus, ischaemic heart disease, atrial fibrillation, chronic kidney disease, chronic obstructive pulmonary disease, liver disease, neoplasms, and mental disorders due to known physiological conditions. After propensity score matching, there were 952 cases and 952 historical controls; cases and historical controls were better balanced on all included characteristics (all <i>p</i> &#x3e; 0.05). After propensity score matching, Kaplan-Meier survival analysis showed the survival probability was significantly lower in ischaemic stroke patients with COVID-19 (78.3% vs. 91.0%, log-rank test <i>p</i> &#x3c; 0.0001). The odds of 60-day mortality were significantly higher for patients with ischaemic stroke and COVID-19 compared to the propensity score-matched historical controls (odds ratio: 2.51 [95% confidence interval 1.88–3.34]). <b><i>Discussion/Conclusions:</i></b> Ischaemic stroke patients with COVID-19 had significantly higher 60-day all-cause mortality compared to propensity score-matched historical controls (ischaemic stroke patients without COVID-19).

Surgical resection of the primary lesion for osteosarcoma patients with metastasis at initial diagnosis

2020 ◽  
Author(s):  
Liuzhe Zhang ◽  
Toru Akiyama ◽  
Takashi Fukushima ◽  
Shintaro Iwata ◽  
Katsushi Takeshita ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Confidence Interval ◽  
Propensity Score Matching ◽  
Surgical Resection ◽  
Primary Lesion ◽  
Rank Test ◽  
Factors Affecting ◽  
Kaplan Meier ◽  
Unresectable Metastasis

Abstract Background Approximately 10–20% of osteosarcoma patients present with metastasis on diagnosis. Completely resecting the lesion is associated with better prognosis. However, evidence regarding optimal surgical strategies for patients with unresectable metastasis is limited. Methods This retrospective analysis was based on the Japanese Nationwide Bone and Soft Tissue Tumor registry. In total, 335 patients diagnosed with osteosarcoma with metastasis were included. Factors affecting overall survival were identified using multivariate analysis. Kaplan–Meier method was used to compare the overall survival by the status of surgical intervention. Two hundred and four patients who did not undergo surgery for metastasis were divided into two groups, depending on whether they underwent surgery for the primary lesion. The background differences between these two groups were adjusted with propensity score matching, with 43 patients per group. The overall survival was calculated using the Kaplan–Meier method and compared with a log-rank test. Results Factors positively impacting overall survival were age &lt;40, female sex, extremity origin, surgery for the primary lesions, surgery for metastasis and radiotherapy without surgery. For patients with unresectable metastasis, after propensity score matching, the survival rate was higher in the group that underwent primary lesion surgery than the group without surgery. Their median survival was 19 (95% confidence interval: 11.7–26.3) and 11 months (95% confidence interval: 4.5–17.5) (P = 0.02), respectively. Conclusions Surgical resection of the primary osteosarcoma lesion did not worsen prognosis, even in patients with unresectable metastasis. Further study is needed to identify which patient group will benefit from primary lesion resection.

scholarly journals Re-work Program in Japan—Overview and Outcome of the Program

2021 ◽  
Vol 11 ◽  
Author(s):  
Yoko Ohki ◽  
Yoshio Igarashi ◽  
Keita Yamauchi
Keyword(s):  
Propensity Score ◽  
Sick Leave ◽  
Propensity Score Matching ◽  
Controlled Trial ◽  
Working Environment ◽  
Rank Test ◽  
Treatment As Usual ◽  
Work Program ◽  
Kaplan Meier ◽  
Work Continuation

Background: The objective of this study was to examine the effect of the Japanese re-work program (RP) to aid in recurrent sick leave prevention.Methods: A multicenter retrospective cohort research was conducted for workers who returned to work (RTW) after sick leave due to mood disorder. Work continuation for subjects who RTW after RP participation and treatment as usual (TAU) and subjects who received TAU only were compared. The Kaplan–Meier method and Cox proportional hazard models were utilized. Additionally, propensity score matching was conducted to control for possible confounds.Results: Log-rank test of overall cohort (n = 323) showed that work continuation of RP + TAU subjects was significantly better compared to that of TAU-only subjects (p = 0.001). Multivariate analysis found a hazard rate of recurrent sick leave for TAU-only subjects of 2.121 (p = 0.001, 95% CI: 1.360–3.309). Additionally, the propensity score-matched cohort (n = 100) had similar differences (p = 0.008), with a hazard ratio of recurrent sick leave of 2.871 (p = 0.009, 95% CI: 1.302–6.331) for TAU-only subjects.Limitations: Only workers who RTW after sick leave were targeted, and no examination was made considering cases who dropped out from RP or TAU. Moreover, the sample was a non-randomized controlled trial, with propensity score matching performed. However, there was an inability to retrieve and adjust for working environment background factors after RTW.Conclusions: Work continuation of subjects with RP was observed to be significantly better, suggesting that the RP was effective for recurrent sick leave prevention.

scholarly journals Prognostic value of Onodera’s nutritional index for intermediate- and high-risk gastrointestinal stromal tumors treated with or without tyrosine kinase inhibitors

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Feng Wang ◽  
Tingting Tao ◽  
Heng Yu ◽  
Yingying Xu ◽  
Zhi Yang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Prognostic Marker ◽  
Gastrointestinal Stromal Tumors ◽  
Prognostic Value ◽  
Kinase Inhibitors ◽  
Rank Test ◽  
Stromal Tumors ◽  
Lymphocyte Ratio ◽  
Nutritional Index

Abstract Background Immunoinflammatory and nutritional markers, such as the peripheral blood neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and Onodera’s prognostic nutritional index (OPNI), have gained considerable attention and have been preliminarily revealed as prognostic markers of gastrointestinal stromal tumors (GISTs). Methods In this study, we first investigated the prognostic value of OPNI in GISTs treated with or without TKIs based on the propensity score matching (PSM) method. All of the patients had received surgical resection for primary GIST, and data from 2010 to 2018 were initially and retrospectively identified from our gastrointestinal center. Recurrence-free survival (RFS) was calculated by the Kaplan–Meier method and compared by the log-rank test. Results The patients were divided into groups treated and not treated with TKIs, and we used the propensity score matching method to homogenize their baseline data. Multivariate Cox proportional hazard regression models were applied to identify associations with outcome variables. A total of 563 GISTs were initially chosen, and 280 of them were included for analysis under the inclusion criteria. After PSM, there were 200 patients included. Multivariate analyses identified OPNI as an independent prognostic marker that was associated with primary site, tumor size, mitotic index, tumor rupture, necrosis, and modified NIH risk classification. Low OPNI (< 42.6; HR 0.409; P < 0.001) was associated with worse RFS. Conclusions Preoperative OPNI is a novel and useful prognostic marker for GISTs both treated and not treated with TKIs. Higher NLR and PLR have negative effects on RFS.

Abstract 67: Effects of Single vs Dual Antiplatelet Therapy on Long Term Stroke and Death After Carotid Endarterectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nathan Belkin ◽  
Alexander S Fairman ◽  
Benjamin M Jackson ◽  
Paul J Foley ◽  
Scott M Damrauer ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Propensity Score ◽  
Carotid Endarterectomy ◽  
Propensity Score Matching ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Long Term Effects ◽  
Kaplan Meier ◽  
One Year

Introduction: Current evidence suggests that dual antiplatelet therapy (DAPT) reduces perioperative stroke, but increases bleeding after carotid endarterectomy (CEA). The long term effects of antiplatelet therapy after CEA have yet to be studied. Methods: A retrospective review of patients undergoing CEA in the national Vascular Quality Initiative database (2003-2018) was performed. Based on antiplatelet regimen at discharge, patients were propensity score matched on aspirin monotherapy vs. DAPT. Multivariable logistic regression and Kaplan-Meier analyses were used to investigate the long term effects of antiplatelet regimen on mortality and stroke/TIA. Results: Of the 72,122 patients undergoing CEA, 64.6% were discharged on aspirin, and 35.4% on DAPT. The DAPT group had higher frequencies of comorbidities (COPD, HTN, CHF, smoking, diabetes) as well as atherosclerotic diseases (PAD, CAD, prior PCI, prior CABG). After propensity score matching, two groups of 8,722 patients with comparable comorbidities were formed. While unmatched Kaplan-Meier analysis showed the DAPT cohort to have higher mortality (p=0.001), this difference dissipated after matching. The resultant matched DAPT cohort did not differ from the aspirin group in one year stroke/TIA (1.7% vs. 1.6%, p=0.70), or mortality (3.1% vs. 3.3%, p=0.55). At 5 years, however, patients treated with DAPT did exhibit a mortality benefit (6.4% vs. 7.3%, p=0.02) with multivariable logistic regression identifying DAPT as an independent predictor of reduced mortality (OR 0.94, 95% CI 0.88-0.99, p=0.04). Conclusions: Patients discharged on DAPT after CEA represent a significantly different cohort than those discharged on aspirin monotherapy. After propensity score matching, there was no difference at one year stroke/TIA or mortality outcomes, but DAPT was found to be protective against long-term mortality. Further study is warranted to investigate this finding.

Multiple imputation analysis for propensity score matching with missing causes of failure: An application to hepatocellular carcinoma data

2021 ◽  
pp. 096228022110370
Author(s):  
Seungbong Han ◽  
Kam-Wah Tsui ◽  
Hui Zhang ◽  
Gi-Ae Kim ◽  
Young-Suk Lim ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Chronic Hepatitis ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Survival Data ◽  
Observational Studies ◽  
Imputation Method ◽  
Competing Risk ◽  
Data Imputation ◽  
Causes Of Failure

Propensity score matching is widely used to determine the effects of treatments in observational studies. Competing risk survival data are common to medical research. However, there is a paucity of propensity score matching studies related to competing risk survival data with missing causes of failure. In this study, we provide guidelines for estimating the treatment effect on the cumulative incidence function when using propensity score matching on competing risk survival data with missing causes of failure. We examined the performances of different methods for imputing the data with missing causes. We then evaluated the gain from the missing cause imputation in an extensive simulation study and applied the proposed data imputation method to the data from a study on the risk of hepatocellular carcinoma in patients with chronic hepatitis B and chronic hepatitis C.

scholarly journals Syndecan-1, an indicator of endothelial glycocalyx degradation, predicts outcome of patients admitted to an ICU with COVID-19

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Dong Zhang ◽  
Liubing Li ◽  
Yu Chen ◽  
Jie Ma ◽  
Yanli Yang ◽  
...  
Keyword(s):  
Laboratory Data ◽  
Endothelial Damage ◽  
Endothelial Glycocalyx ◽  
Rank Test ◽  
Inflammatory Reactions ◽  
Log Rank Test ◽  
Survivor Group ◽  
Kaplan Meier ◽  
Factor Α ◽  
Necrosis Factor

Abstract Background We investigated the feasibility of two biomarkers of endothelial damage (Syndecan-1 and thrombomodulin) in coronavirus disease 2019 (COVID-19), and their association with inflammation, coagulopathy, and mortality. Methods The records of 49 COVID-19 patients who were admitted to an intensive care unit (ICU) in Wuhan, China between February and April 2020 were examined. Demographic, clinical, and laboratory data, and outcomes were compared between survivors and non-survivors COVID-19 patients, and between patients with high and low serum Syndecan-1 levels. The dynamics of serum Syndecan-1 levels were also analyzed. Results The levels of Syndecan-1 were significantly higher in non-survivor group compared with survivor group (median 1031.4 versus 504.0 ng/mL, P = 0.002), and the levels of thrombomodulin were not significantly different between these two groups (median 4534.0 versus 3780.0 ng/mL, P = 0.070). Kaplan–Meier survival analysis showed that the group with high Syndecan-1 levels had worse overall survival (log-rank test: P = 0.023). Patients with high Syndecan-1 levels also had significantly higher levels of thrombomodulin, interleukin-6, and tumor necrosis factor-α. Data on the dynamics of Syndecan-1 levels indicated much greater variations in non-survivors than survivors. Conclusions COVID-19 patients with high levels of Syndecan-1 develop more serious endothelial damage and inflammatory reactions, and have increased mortality. Syndecan-1 has potential for use as a marker for progression or severity of COVID-19. Protecting the glycocalyx from destruction is a potential treatment for COVID-19.

Abstract 14598: Multiple Arterial Coronary Bypass Grafting is Associated With Improved Survival in Females

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Derrick Tam ◽  
Rodolfo Rocha ◽  
Jiming Fang ◽  
Maral Ouzounian ◽  
Joanna Chikwe ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Administrative Databases ◽  
Rank Test ◽  
Bypass Grafting ◽  
Female Patients ◽  
Significant Difference ◽  
Arterial Grafting

Introduction: Multiple arterial grafting (MAG) in coronary artery bypass grafting (CABG) is associated with improved survival and freedom from major adverse cardiac and cerebrovascular events (MACCE) in observational studies of mostly males. It is not known whether the MAG is beneficial in females. Herein, we compared the late clinical outcomes of MAG versus single arterial grafting (SAG) in females undergoing CABG for multivessel coronary artery disease (CAD) Methods: Clinical and administrative databases for Ontario, Canada, were linked to obtain all female patients with angiographic evidence of left main, triple, or double vessel disease undergoing isolated non-emergent primary CABG from 2008-2019. Baseline characteristics were compared and 1:1 propensity score matching was performed to account for differences. 30-day mortality was compared in the matched groups. Late mortality and MACCE ( composite of stroke, myocardial infarction, repeat revascularization, and death) was compared between the matched groups with a stratified log rank test and Cox-proportional hazard model. Results: In total 2,961 and 7,954 females underwent CABG with MAG and SAG respectively for multivessel CAD. Prior to propensity-score matching, compared to SAG, those that underwent MAG were younger (66.0 vs. 68.9 years) and had less comorbidities. After propensity-score matching, 2,446 well-matched pairs were formed. In matched patients, there was no significant difference in 30-day mortality (1.6% vs 1.8%, P=0.43) between MAG and SAG. The median and maximum follow-up was 5.0 and 11.0 years respectively. Over the entire follow-up, MAG was associated with improved survival (Figure, hazard ratio (HR): 0.85, 95% confidence interval (CI): 0.75-0.98) and freedom from MACCE (HR: 0.85, 95%CI: 0.76-0.95). Conclusions: MAG was associated with improved survival and freedom from MACCE and should be considered for female patients with good life expectancy requiring CABG.

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