Coronary Risk Stratification in Patients with Ischemic Stroke or Transient Ischemic Stroke Attack

2007 ◽  
Vol 2 (3) ◽  
pp. 177-183 ◽  
Author(s):  
Emmanuel Touzé ◽  
Olivier Varenne ◽  
David Calvet ◽  
Jean-Louis Mas
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Absolute Risk ◽  
Scoring Systems ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Absolute ◽  
Coronary Events ◽  
Traditional Risk Factors ◽  
Cad Risk

Background The risk of coronary artery disease (CAD) is traditionally considered high in patients who had an ischemic stroke or a transient ischemic attack (TIA). However, few studies have specifically assessed the absolute risk of coronary events in those patients and predictors of such events are not well known. Summary of review The overall risks of myocardial infarction and nonstroke vascular death are each around 2% per year. However, those risks are only about 1% per year in patients without CAD (i.e. the only ones who are likely to benefit from specific additional strategies). The prevalence of asymptomatic CAD ranges from 15% to 60%. Although potentially higher, the risk of CAD in patients with stroke/TIA related to atherosclerosis also seems to vary widely depending on the extent of the disease. Given the relatively low CAD risk, a simple systematic reinforcement of medical treatment in all patients may be not relevant. Up to now, there have been only limited ways to stratify the CAD risk in stroke/TIA patients. High-risk patients may be identified using the traditional cardiac scoring systems, but their validity has never been specifically assessed in stroke populations. The relative influence of traditional risk factors may be altered after a first vascular event. Stroke patients could also be screened for asymptomatic CAD. However, there is no simple and valid screening test for asymptomatic CAD that could be applied to all patients. Finally, there is still uncertainty about the potential benefits of treating asymptomatic CAD. Therefore, should the identification of patients with asymptomatic CAD requiring revascularization become feasible, the relevance of this strategy would remain to be evaluated by a randomized clinical trial. Conclusion The absolute risk of CAD in stroke/TIA patients is moderately high. More research is needed to identify high risk patients who could benefit from specific strategies.

scholarly journals APACHE IV system helps to determine cholecystostomy role in elderly patients with acute cholecystitis

2020 ◽  
Author(s):  
Hua Jiang ◽  
Guo Guo ◽  
Zhimin Yao ◽  
Yuehua Wang
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Therapeutic Effect ◽  
Scoring System ◽  
Scoring Systems ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Before And After ◽  
Risk Patients ◽  
Apache Iv

Abstract Background Cholecystostomy offers an alternative method for patients unfit to undergo immediate cholecystectomy. Nevertheless, the role of cholecystostomy in the clinical management of high-risk surgical patients remains unclear. One of the main problems concerning the therapeutic effect in critically ill patients with acute cholecystitis is the lack of validated, well-established scoring systems to stratify the severity of patient disease states. APACHE IV scoring system was useful to estimate the hospital mortality for high-risk patients. We try to evaluate the performance of the APACHE IV scoring system in patients over 65 years of age with acute cholecystitis and the therapeutic effect of percutaneous cholecystostomy. Methods 597 patients over 65 years of age with acute cholecystitis between January 2011 and December 2018 were retrospectively analyzed with the APACHE IV scores. Results Among the 597 patients, 52 successfully underwent cholecystectomy (2 died, 3.85%), 65 underwent percutaneous cholecystostomy (1 died, 1.54%), and 480 received conservative therapy (27 died, 5.63%). The fitness of the APACHE IV score prediction is good with the area under the ROC curve of 0.894. The APACHE IV models were well-calibrated (with the Hosmer-Lemeshow statistic). Using the method of binary regression analysis, for the patients whose estimated mortality rate was more than 10%, cholecystostomy was an important factor for prognosis (P = 0.048). The estimated mortality of PC patients before and after operation was compared, which indicated that the estimated mortality after puncture was significantly decreased, either in the whole patient group (P = 0.004) or in the group with an estimated mortality greater than 10% (P = 0.008). Conclusion The APACHE IV scoring system showed that cholecystostomy was a safe and effective treatment for elderly high-risk patients with acute cholecystitis.

scholarly journals Decisions to operate: the ASA grade 5 dilemma

2011 ◽  
Vol 93 (5) ◽  
pp. 365-369 ◽  
Author(s):  
J Horwood ◽  
S Ratnam ◽  
A Maw
Keyword(s):  
High Risk ◽  
Scoring Systems ◽  
Apache Ii ◽  
Ageing Population ◽  
Mortality And Morbidity ◽  
High Risk Patients ◽  
Operative Severity Score ◽  
Grade 5 ◽  
Number Of Patients ◽  
Risk Patients

INTRODUCTION Deciding to operate on high risk patients suffering catastrophic surgical emergencies can be problematic. Patients are frequently classed as American Society of Anesthesiologists (ASA) grade 5 and, as a result, aggressive but potentially lifesaving intervention is withheld. The aim of our study was to review the short-term outcomes in patients who were classed as ASA grade 5 but subsequently underwent surgery despite this and to compare the ASA scoring model to other predictors of surgical outcome. METHODS All patients undergoing emergency surgery with an ASA grade of 5 were identified. Patient demographics, indications for surgery, intraoperative findings and outcomes were recorded. In addition to the ASA scores, retrospective Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P POSSUM) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated and compared to the observed outcomes. RESULTS Nine patients (39%) survived to discharge. ASA grade was a poor predictor of outcome. P POSSUM and APACHE II scores correlated significantly with each other and with observed outcomes when predicting surgical mortality. The median stay for survivors in the intensive care unit was nine days. CONCLUSIONS In times of an ageing population, the number of patients suffering catastrophic surgical events will increase. Intervention, with little hope of a cure, a return to independent living or an acceptable quality of life, leads to unnecessary end-of-life suffering for patients and their relatives, and consumes sparse resources. The accuracy and reliability of ASA grade 5 as an outcome predictor has been questioned. P POSSUM and APACHE II scoring systems are significantly better predictors of outcome and should be used more frequently to aid surgical decision-making in high risk patients.

Predictors of Maternal Mortality and Prognostic Models in Obstetric Patients

2017 ◽  
Vol 38 (02) ◽  
pp. 191-200 ◽  
Author(s):  
Jezid Miranda ◽  
Jose Rojas-Suarez ◽  
Andrew Levinson
Keyword(s):  
High Risk ◽  
Maternal Morbidity ◽  
Prediction Models ◽  
Severity Of Illness ◽  
Scoring Systems ◽  
Morbidity And Mortality ◽  
Prognostic Models ◽  
High Risk Patients ◽  
Maternal Morbidity And Mortality ◽  
Risk Patients

AbstractThe use of predictive models has been proposed as a potential tool to reduce maternal morbidity and mortality, by aiding in the timely identification of potential high-risk patients. Prognostic models in critical care have been used to characterize the severity of illness of specific diseases. Physiological changes in pregnancy may result in general critical illness prediction models overestimating mortality in obstetric patients. Models that specifically reflect the unique characteristics of obstetric patients may have better prognostic value. Recently developed tools have focused on identifying at-risk patients before they require intensive care unit (ICU) admission to target early interventions and prevent acute clinical decompensation. The aim of the newest scoring systems, specifically designed for groups of obstetric patients receiving non-ICU care, is to reduce maternal morbidity and mortality by identifying early high-risk patients and initiating prompt effective medical responses.

The PlA1/A2 polymorphism of glycoprotein IIIa and cerebrovascular events in hypertension: increased risk of ischemic stroke in high-risk patients

2007 ◽  
Vol 25 (3) ◽  
pp. 551-556 ◽  
Author(s):  
Francesca Lanni ◽  
Gaetano Santulli ◽  
Raffaele Izzo ◽  
Speranza Rubattu ◽  
Bastianina Zanda ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
High Risk Patients ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Glycoprotein Iiia ◽  
Risk Patients

INTEGRATION OF APACHE II AND III SCORING SYSTEMS IN EXTREMELY HIGH RISK PATIENTS WITH ACUTE RENAL FAILURE TREATED BY DIALYSIS

Renal Failure ◽  
2002 ◽  
Vol 24 (3) ◽  
pp. 285-296 ◽  
Author(s):  
Yung-Chang Chen ◽  
Hsiang-Hao Hsu ◽  
Chen-Yin Chen ◽  
Ji-Tseng Fang ◽  
Chiu-Ching Huang
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
High Risk ◽  
Scoring Systems ◽  
Apache Ii ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Proportion of US Hospitalized Medically Ill Patients Who May Qualify for Extended Thromboprophylaxis

2019 ◽  
Vol 25 ◽  
pp. 107602961985089 ◽  
Author(s):  
Benjamin Miao ◽  
Bhavana Chalupadi ◽  
Brendan Clark ◽  
Alexis Descoteaux ◽  
Daniel Huang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Venous Thromboembolism ◽  
Respiratory Failure ◽  
High Risk ◽  
Inflammatory Diseases ◽  
The United States ◽  
Medically Ill ◽  
High Risk Patients ◽  
Risk Patients ◽  
Medically Ill Patients

Extended thromboprophylaxis with oral anticoagulation can reduce the risk of symptomatic venous thromboembolism (VTE) in high-risk patients. We sought to estimate the proportion of medically ill patients in the United States who might qualify for extended thromboprophylaxis according to the criteria used in the Medically-Ill Patient Assessment of Rivaroxaban versus Placebo in Reducing Post-Discharge Venous ThromboEmbolism Risk (MARINER) trial. We analyzed 2014 National Inpatient Sample (NIS) data that provide a 20% weighted annual sample of all discharges from US acute-care hospitals. Hospitalizations for acute medically ill patients were identified as those with a primary discharge diagnosis code for heart or respiratory failure, ischemic stroke, infection, or inflammatory diseases. Patients were excluded if they were <40 years old, admitted for surgery or trauma, had a length of stay <3- or >35-days, or were contraindicated to nonvitamin K antagonist oral anticoagulants. The modified International Medical Prevention Registry on Venous Thromboembolism (IMPROVE)-VTE score was used to stratify patients’ risk for postdischarge VTE, with a score of 2 to 3 suggesting patients were at moderate- and ≥4 as high-risk. Of the 35 358 810 hospitalizations in the 2014 NIS, 1 849 535 were medically ill patients admitted for heart failure (10.1%), respiratory failure (12.2%), ischemic stroke (8.8%), infection (58.5%), or inflammatory diseases (10.4%). The modified IMPROVE-VTE score classified 1 186 475 (64.1%) of these hospitalizations as occurring in moderate-risk and 407 095 (22.0%) in high-risk patients. This real-world study suggests a substantial proportion of acute medically ill patients might benefit from extended thromboprophylaxis using the modified IMPROVE-VTE score and clinical elements of the MARINER trial.

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