Adverse events in patients with high platelet reactivity following successful chronic total occlusion PCI: The Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents (ADAPT-DES) study.

BACKGROUND: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) typically requires a greater number of stents and longer stent length than non-CTO PCI, placing these patients at greater risk for adverse ischemic events. We sought to determine whether the association between high platelet reactivity (HPR) and the risk of ischemic events is stronger after CTO than non-CTO PCI. METHODS: Patients undergoing successful PCI in the multicenter ADAPT-DES study were stratified according to whether they underwent PCI of a CTO. HPR was defined as VerifyNow platelet reaction units >208. The study primary endpoint was the 2-year risk target vessel failure ([TVF] defined as cardiac death, myocardial infarction, or target lesion revascularization). RESULTS: CTO PCI was performed in 400 of 8448 patients. HPR was present in 34.5% of CTO PCI patients and 43.1% of non-CTO PCI patients (P = .0007). Patients undergoing CTO PCI with versus without HPR had significantly higher 2-year rates of TVF (15.0% versus 8.3%, P = .04) without significant differences in bleeding. HPR was an independent predictor of 2-year TVF (adjusted HR 1.16, 95% CI 1.02-1.34, P = .03) whereas CTO PCI was not (adjusted HR 0.89, 95% CI 0.65-1.22, P = .48). There was a significant interaction between CTO versus non-CTO PCI and PRU as a continuous variable for 2-year TVF (Pinteraction = 0.02). CONCLUSIONS: In ADAPT-DES, HPR was associated with an increased 2-year risk of TVF after PCI, an association that was at least as strong after CTO PCI compared with non-CTO PCI.

Caregiver burden and coping patterns of Chinese parents of a child with a mental illness.

The burden of providing care to a family member, who has a mental illness, has been investigated in the past. However, limited research has focused on how parents cope, as they attempt to maintain a functional family life, when they have a child with a mental illness. This study explored, using a descriptive correlational design, the: (i) differences between parents of a child with mental illness, regarding caregiver burden, coping patterns, and demographic characteristics; (ii) effect parental educational level, parental working status, educational level of the child, diagnosis of the child, and family economic status have on parental caregiver burden and coping patterns; (iii) relationships among caregiver burden and coping patterns; and (iv) demographic characteristics of parents and children that predict caregiver burden and parental coping patterns. Data were collected via interview using structured questionnaires, from 97 mainland Chinese parents who had a child with a mental illness. The findings revealed the parents perceived significant caregiver burden, while caring for their child with a mental illness, yet used limited coping patterns to maintain a functional family life. Also, a significant negative correlation was found between the parents' caregiver burden and the way of coping. Parental physical health and the child's educational level were the best predictors of caregiver burden, while parental physical health and educational levels were the best predictors of the way of coping. Findings suggest that effective nursing interventions should be instituted to help parents of a child with mental illness cope with caregiver burden, while maintaining a functional family life.