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1.
Artigo em Inglês | MEDLINE | ID: mdl-32404852

RESUMO

: The need for multiple transducer positions, especially from right parasternal windows, is consistently mentioned in the recommendations for the accurate measurement of peak velocities across a stenotic aortic valve, but yet poorly adopted.We performed a subanalysis of the largest prospective series on the right parasternal acoustic windows in patients with aortic stenosis (330 consecutive) to calculate the degree of misalignment and estimate the potential outcome implication of this often-forgotten approach.The right parasternal view was highly feasible with an average estimated misalignment from the apical view of 14 ±â€Š16 degree; in 10 cases, an estimated misalignment >40 degree. Right parasternal assessment (vs. apical alone) provided a significant reclassification from moderate to severe or even very-severe aortic valve stenosis. Considering a wellestablished survival benefit provided by either percutaneous or surgical valve replacement in patients with severe aortic stenosis the reclassification would result in approximately 1 life-year saved for every 30-35 patients in whom parasternal view were effectively utilized.

2.
Am J Infect Control ; 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32192754

RESUMO

PURPOSE: To identify and characterize studies evaluating clinician compliance with infection-related guidelines, and to explore trends in guideline design and implementation strategies. DATA SOURCES: PubMed database, April 2017. Followed the PRISMA Statement for systematic reviews. STUDY SELECTION: Scope was limited to studies reporting compliance with guidelines pertaining to the prevention, detection, and/or treatment of acute hospital-based infections. Initial search (1,499 titles) was reduced to 49 selected articles. DATA EXTRACTION: Extracted publication and guideline characteristics, outcome measures reported, and any results related to clinician compliance. Primary summary measures were frequencies and distributions of characteristics. Interventions that led to improved compliance results were analyzed to identify trends in guideline design and implementation. RESULTS OF DATA SYNTHESIS: Of the 49 selected studies, 18 (37%), 13 (27%), and 10 (20%) focused on sepsis, pneumonia, and general infection, respectively. Six (12%), 17 (35%), and 26 (53%) studies assessed local, national, and international guidelines, respectively. Twenty studies (41%) reported 1-instance compliance results, 28 studies (57%) reported 2-instance compliance results (either before-and-after studies or control group studies), and 1 study (2%) described compliance qualitatively. Average absolute change in compliance for minimal, decision support, and multimodal interventions was 10%, 14%, and 25%, respectively. Twelve studies (24%) reported no patient outcome alongside compliance. CONCLUSIONS: Multimodal interventions and quality improvement initiatives seem to produce the greatest improvement in compliance, but trends in other factors were inconsistent. Additional research is required to investigate these relationships and understand the implications behind various approaches to guideline design, communication, and implementation, in addition to effectiveness of protocol impact on relevant patient outcomes.

3.
Int J Med Inform ; 137: 104072, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32200295

RESUMO

BACKGROUND: To explore attitudes about artificial intelligence (AI) among staff who utilized AI-based clinical decision support (CDS). METHODS: A survey was designed to assess staff attitudes about AI-based CDS tools. The survey was anonymously and voluntarily completed by clinical staff in three primary care outpatient clinics before and after implementation of an AI-based CDS system aimed to improve glycemic control in patients with diabetes as part of a quality improvement project. The CDS identified patients at risk for poor glycemic control and generated intervention recommendations intended to reduce patients' risk. RESULTS: Staff completed 45 surveys pre-intervention and 38 post-intervention. Following implementation, staff felt that care was better coordinated (11 favorable responses, 14 unfavorable responses pre-intervention; 21 favorable responses, 3 unfavorable responses post-intervention; p < 0.01). However, only 14 % of users would recommend the AI-based CDS. Staff feedback revealed that the most favorable aspect of the CDS was that it promoted team dialog about patient needs (N = 14, 52 %), and the least favorable aspect was inadequacy of the interventions recommended by the CDS. CONCLUSIONS: AI-based CDS tools that are perceived negatively by staff may reduce staff excitement about AI technology, and hands-on experience with AI may lead to more realistic expectations about the technology's capabilities. In our setting, although AI-based CDS prompted an interdisciplinary discussion about the needs of patients at high risk for poor glycemic control, the interventions recommended by the CDS were often perceived to be poorly tailored, inappropriate, or not useful. Developers should carefully consider tasks that are best performed by AI and those best performed by the patient's care team.

4.
Otol Neurotol ; 40(9): 1217-1223, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31469793

RESUMO

OBJECTIVE: The Dizziness Handicap Inventory (DHI) is a 25-item self-report questionnaire developed to measure the disabling and handicapping impact of dizziness. The present investigation was conducted in an effort to re-assess the factor structure of the DHI. STUDY DESIGN: Retrospective study. SETTING: Tertiary care center. PATIENTS: Subjects were 1,991 patients who were evaluated in the Mayo Clinic-Rochester Vestibular and Balance Laboratory. MAIN OUTCOME MEASURES: Exploratory factor analysis: an exploratory bifactor analysis (EFA) with bifactor rotation was used to analyze a random sample of 999 patients. Analyses were used to determine the dominance of the general factor (i.e., total score) relative to the group factor (i.e., subscales). Confirmatory factor analysis: a confirmatory bifactor graded response model was fit with appropriate item-to-group relationships that was discovered by our exploratory analyses. To validate the bifactor model that was identified with the exploratory analyses, a bifactor model with three grouping factors (i.e., Physical manifestations, Catastrophic impact of dizziness, and the Emotional impact of dizziness) were fit to a different random sample of 992 patients using the new item-to-group factor specifications. RESULTS: In the confirmatory analyses, all items had a positive factor loading on the general factor. There were 14 items that loaded on the general factor only. The rest of the items (n = 11) loaded on both the general factor and one of three group factors. CONCLUSIONS: Conclusions of the study revealed several findings: 1) reporting the result as a total score (i.e., a single general factor) is warranted, and, 2) there is statistical support for the existence of three subscales representing: the Physical manifestations, Catastrophic impact, and Emotional impact of dizziness and vertigo.

5.
BMJ Open ; 8(1): e015550, 2018 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-29358415

RESUMO

OBJECTIVE: Create a score to identify patients at risk of death or hospice placement who may benefit from goals of care discussion earlier in the hospitalisation. DESIGN: Retrospective cohort study to develop a risk index using multivariable logistic regression. SETTING: Two tertiary care hospitals in Southeastern Minnesota. PARTICIPANTS: 92 879 adult general care admissions (50% male, average age 60 years). PRIMARY AND SECONDARY OUTCOME MEASURES: Our outcome measure was an aggregate of inhospital death or discharge to hospice. Predictor variables for the model encompassed comorbidities, nutrition status, functional status, demographics, fall risk, mental status, Charlson Comorbidity Index and acuity of illness on admission. Resuscitation status, race, geographic area of residence and marital status were added as covariates to account for confounding. RESULTS: Inhospital mortality and discharge to hospice were rare, with incidences of 1.2% and 0.8%, respectively. The Hospital End-of-Life Prognostic Score (HELPS) demonstrated good discrimination (C-statistic=0.866 in derivation set and 0.834 in validation set). The patients with the highest 5% of scores had an 8% risk of the outcome measure, relative risk 12.9 (10.9-15.4) when compared to the bottom 95%. CONCLUSIONS: HELPS is able to identify patients with a high risk of inhospital death or need for hospice at discharge. These patients may benefit from early goals of care discussions.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Mortalidade Hospitalar , Planejamento de Assistência ao Paciente , Transferência de Pacientes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Minnesota , Análise Multivariada , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Adulto Jovem
6.
AMIA Annu Symp Proc ; 2018: 942-951, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30815137

RESUMO

Visualizing process metrics can help identify targets for improvement initiatives. Dashboards and scorecards are tools to visualize important metrics in an easily interpretable manner. We describe the development of two visualization systems: a dashboard to provide real-time situational awareness to frontline coordinators, and a scorecard to display aggregate monthly performance metrics for strategic process improvement efforts. Both systems were designed by a multidisciplinary team of physicians, allied health staff, engineers and information technology specialists. We describe the process of defining important metrics, gathering and cleaning data, and designing the visualization interfaces. We also describe some improvement initiatives that stemmed. These systems were implemented in our hospital and improved the availability of data to our staff and leadership, making performance gaps visible and generating new targets for quality improvement projects.


Assuntos
Apresentação de Dados , Visualização de Dados , Serviço Hospitalar de Radiologia/organização & administração , Sistemas de Informação em Radiologia , Serviços de Informação , Recursos Humanos em Hospital , Melhoria de Qualidade , Interface Usuário-Computador
7.
J Hosp Med ; 12(4): 217-223, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28411289

RESUMO

BACKGROUND: The use of rapid response systems (RRS), which were designed to bring clinicians with critical care expertise to the bedside to prevent unnecessary deaths, has increased. RRS rely on accurate detection of acute deterioration events. Early warning scores (EWS) have been used for this purpose but were developed using heterogeneous populations. Predictive performance may differ in medical vs surgical patients. OBJECTIVE: To evaluate the performance of published EWS in medical vs surgical patient populations. DESIGN: Retrospective cohort study. SETTING: Two tertiary care academic medical center hospitals in the Midwest totaling more than 1500 beds. PATIENTS: All patients discharged from January to December 2011. INTERVENTION: None. MEASUREMENTS: Time-stamped longitudinal database of patient variables and outcomes, categorized as surgical or medical. Outcomes included unscheduled transfers to the intensive care unit, activation of the RRS, and calls for cardiorespiratory resuscitation ("resuscitation call"). The EWS were calculated and updated with every new patient variable entry over time. Scores were considered accurate if they predicted an outcome in the following 24 hours. RESULTS: All EWS demonstrated higher performance within the medical population as compared to surgical: higher positive predictive value (P < .0001 for all scores) and sensitivity (P < .0001 for all scores). All EWS had positive predictive values below 25%. CONCLUSIONS: The overall poor performance of the evaluated EWS was marginally better in medical patients when compared to surgical patients. Journal of Hospital Medicine 2017;12:217-223.


Assuntos
Cuidados Críticos , Estado Terminal/mortalidade , Indicadores Básicos de Saúde , Equipe de Respostas Rápidas de Hospitais/normas , Tomada de Decisões , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sinais Vitais
8.
Plast Reconstr Surg ; 139(1): 128-136, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28027238

RESUMO

BACKGROUND: Reconstruction after pan-plexus root avulsions often includes gracilis free functioning muscle transfer. For elbow flexion reconstruction, the free functioning muscle transfer distal tendon is inserted into the biceps tendon or more distally (i.e., flexor digitorum profundus/flexor pollicis longus tendons) for combined elbow and finger flexion; the theoretical drawback of the latter approach is weaker elbow flexion. The authors compared elbow flexion strength with a biceps tendon versus a flexor digitorum profundus/flexor pollicis longus tendon attachment to determine which insertion point resulted in better elbow flexion. METHODS: Thirty-nine patients underwent free functioning muscle transfer with either a biceps tendon or a distal attachment. Groups were compared on postoperative elbow flexion strength, preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores, range of motion, and other surgical and demographic characteristics. A biomechanical analysis simulating different tendon attachments determined which reconstruction resulted in optimal elbow flexion mechanics. RESULTS: Distal tendon attachment was associated with M3 or M4 elbow flexion and greater range of motion compared with the biceps tendon attachment (p < 0.05). There were no statistically significant improvements in Disabilities of the Arm, Shoulder, and Hand questionnaire scores. Biomechanical analysis demonstrated that all distal tendon attachments studied generated a 15 to 30 percent greater torque compared with the biceps tendon attachment; this was true for attachments either at the flexor digitorum profundus/flexor pollicis longus tendon, or directly at the radius at 10 cm or 15 cm from the elbow axis of rotation. CONCLUSIONS: The flexor digitorum profundus/flexor pollicis longus tendon attachment of the gracilis free functioning muscle transfer distal tendon was superior in achieving elbow flexion strength. Patients with only elbow flexion reconstruction may also benefit from a flexor digitorum profundus/flexor pollicis longus tendon attachment or from a more distal attachment to the radius. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Plexo Braquial/lesões , Retalhos de Tecido Biológico/transplante , Músculo Grácil/transplante , Traumatismos dos Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tendões/cirurgia , Adulto , Fenômenos Biomecânicos , Articulação do Cotovelo/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
9.
J Biomed Inform ; 64: 10-19, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27658885

RESUMO

BACKGROUND: Patients in general medical-surgical wards who experience unplanned transfer to the intensive care unit (ICU) show evidence of physiologic derangement 6-24h prior to their deterioration. With increasing availability of electronic medical records (EMRs), automated early warning scores (EWSs) are becoming feasible. OBJECTIVE: To describe the development and performance of an automated EWS based on EMR data. MATERIALS AND METHODS: We used a discrete-time logistic regression model to obtain an hourly risk score to predict unplanned transfer to the ICU within the next 12h. The model was based on hospitalization episodes from all adult patients (18years) admitted to 21 Kaiser Permanente Northern California (KPNC) hospitals from 1/1/2010 to 12/31/2013. Eligible patients met these entry criteria: initial hospitalization occurred at a KPNC hospital; the hospitalization was not for childbirth; and the EMR had been operational at the hospital for at least 3months. We evaluated the performance of this risk score, called Advanced Alert Monitor (AAM) and compared it against two other EWSs (eCART and NEWS) in terms of their sensitivity, specificity, negative predictive value, positive predictive value, and area under the receiver operator characteristic curve (c statistic). RESULTS: A total of 649,418 hospitalization episodes involving 374,838 patients met inclusion criteria, with 19,153 of the episodes experiencing at least one outcome. The analysis data set had 48,723,248 hourly observations. Predictors included physiologic data (laboratory tests and vital signs); neurological status; severity of illness and longitudinal comorbidity indices; care directives; and health services indicators (e.g. elapsed length of stay). AAM showed better performance compared to NEWS and eCART in all the metrics and prediction intervals. The AAM AUC was 0.82 compared to 0.79 and 0.76 for eCART and NEWS, respectively. Using a threshold that generated 1 alert per day in a unit with a patient census of 35, the sensitivity of AAM was 49% (95% CI: 47.6-50.3%) compared to the sensitivities of eCART and NEWS scores of 44% (42.3-45.1) and 40% (38.2-40.9), respectively. For all three scores, about half of alerts occurred within 12h of the event, and almost two thirds within 24h of the event. CONCLUSION: The AAM score is an example of a score that takes advantage of multiple data streams now available in modern EMRs. It highlights the ability to harness complex algorithms to maximize signal extraction. The main challenge in the future is to develop detection approaches for patients in whom data are sparser because their baseline risk is lower.


Assuntos
Registros Eletrônicos de Saúde , Pacientes Internados , Unidades de Terapia Intensiva , Valores Críticos Laboratoriais , Adulto , Idoso , California , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sinais Vitais
10.
Crit Care ; 19: 285, 2015 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-26268570

RESUMO

Metrics typically used to report the performance of an early warning score (EWS), such as the area under the receiver operator characteristic curve or C-statistic, are not useful for pre-implementation analyses. Because physiological deterioration has an extremely low prevalence of 0.02 per patient-day, these metrics can be misleading. We discuss the statistical reasoning behind this statement and present a novel alternative metric more adequate to operationalize an EWS. We suggest that pre-implementation evaluation of EWSs should include at least two metrics: sensitivity; and either the positive predictive value, number needed to evaluate, or estimated rate of alerts. We also argue the importance of reporting each individual cutoff value.


Assuntos
Cuidados Críticos/métodos , Técnicas de Apoio para a Decisão , Cuidados Críticos/normas , Humanos , Curva ROC , Estatística como Assunto
11.
Eur J Dermatol ; 25(4): 329-34, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26065886

RESUMO

BACKGROUND: At present there is still controversy about the relationship between emotional stress and psoriasis lesions. Most of the published literature does not include the broad spectrum of emotional response. OBJECTIVE: The aim of this study was to evaluate the association between skin lesions and emotional state in a large sample of patients with psoriasis. METHODS: 823 psoriasis patients were recruited (mean age 45.9 years, 55.7% female) and answered two online questionnaires: lesion severity and current extension were evaluated using a self-administered psoriasis severity index (SAPASI); emotional state was assessed using the positive and negative affect schedule (PANAS). Second order factors were calculated and correlated with the SAPASI. RESULTS: We found positive associations between the extent and severity of skin lesions and the negative and submissive emotions, a negative correlation with dominance emotions and no association with positive emotions. CONCLUSION: Our data supports the relationship between emotions and skin lesions. It also allows for discrimination of the associations between psoriasis lesions and the specific type of emotions.


Assuntos
Emoções , Psoríase/psicologia , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
12.
Redox Biol ; 5: 420-421, 2015 08.
Artigo em Inglês | MEDLINE | ID: mdl-28162288

RESUMO

Hepatocellular carcinoma develops in cirrhotic liver. The nitric oxide (NO) synthase type III (NOS-3) overexpression induces cell death in hepatoma cells. The study developed gene therapy designed to specifically overexpress NOS-3 in cultured hepatoma cells, and in tumors derived from orthotopically implanted tumor cells in fibrotic livers. Liver fibrosis was induced by CCl4 administration in mice. Hepa 1-6 cells were used for in vitro and in vivo experiments. The first generation adenovirus was designed to overexpress NOS-3 (or GFP) and luciferase cDNA under the regulation of murine alpha-fetoprotein (AFP) and Rous Sarcoma Virus (RSV) promoters, respectively. Both adenoviruses were administered through the tail vein two weeks after orthotopic tumor cell implantation. AFP-NOS-3/RSV-Luciferase increased oxidative-related DNA damage, p53, CD95/CD95L expression and caspase-8 activity in cultured Hepa 1-6 cells. The increased expression of CD95/CD95L and caspase-8 activity was abolished by l-NAME or p53 siRNA. The tail vein infusion of AFP-NOS- 3/RSV-Luciferase adenovirus increased cell death markers, and reduced cell proliferation of established tumors in fibrotic livers. The increase of oxidative/nitrosative stress induced by NOS-3 overexpression induced DNA damage, p53, CD95/CD95L expression and cell death in hepatocellular carcinoma cells. The effectiveness of the gene therapy has been demonstrated in vitro and in vivo.


Assuntos
Adenoviridae , Carcinoma Hepatocelular/terapia , Terapia Genética , Neoplasias Hepáticas Experimentais/terapia , Óxido Nítrico Sintase Tipo III , Animais , Carcinoma Hepatocelular/enzimologia , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas Experimentais/enzimologia , Neoplasias Hepáticas Experimentais/genética , Camundongos , Proteínas de Neoplasias/genética , Proteínas de Neoplasias/metabolismo , Óxido Nítrico Sintase Tipo III/biossíntese , Óxido Nítrico Sintase Tipo III/genética
14.
Pediatr Dermatol ; 31(2): 251-2, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24456035

RESUMO

Transient neonatal zinc deficiency (TNZD) has a clinical presentation similar to that of acrodermatitis enteropathica but is caused by a low zinc concentration in maternal breast milk. TNZD becomes clinically evident during breastfeeding and is resolved by weaning and the introduction of complementary nutrition. We present a 4-month-old girl with TNZD due to a new autosomal dominant mutation (663delC) in the maternal SLC30A2 gene not previously described in the literature.


Assuntos
Proteínas de Transporte de Cátions/genética , Erros Inatos do Metabolismo dos Metais/genética , Mutação , Feminino , Transtornos do Crescimento , Humanos , Lactente , Erros Inatos do Metabolismo dos Metais/tratamento farmacológico , Leite Humano/química , Zinco/uso terapêutico
15.
Resuscitation ; 85(4): 549-52, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24412159

RESUMO

INTRODUCTION: Early Warning Scores (EWS) are widely used for early recognition of patient deterioration. Automated alarm/alerts have been recommended as a desirable characteristic for detection systems of patient deterioration. We undertook a comparative analysis of performance characteristics of common EWS methods to assess how they would function if automated. METHODS: We evaluated the most widely used EWS systems (MEWS, SEWS, GMEWS, Worthing, ViEWS and NEWS) and the Rapid Response Team (RRT) activation criteria in use in our institution. We compared their ability to predict the composite outcome of Resuscitation call, RRS activation or unplanned transfer to the ICU, in a time-dependent manner (3, 8, 12, 24 and 36 h after the observation) by determining the sensitivity, specificity and positive predictive values (PPV). We used a large vital signs database (6,948,689 unique time points) from 34,898 unique consecutive hospitalized patients. RESULTS: PPVs ranged from less than 0.01 (Worthing, 3 h) to 0.21 (GMEWS, 36 h). Sensitivity ranged from 0.07 (GMEWS, 3 h) to 0.75 (ViEWS, 36 h). Used in an automated fashion, these would correspond to 1040-215,020 false positive alerts per year. CONCLUSIONS: When the evaluation is performed in a time-sensitive manner, the most widely used weighted track-and-trigger scores do not offer good predictive capabilities for use as criteria for an automated alarm system. For the implementation of an automated alarm system, better criteria need to be developed and validated before implementation.


Assuntos
Cuidados Críticos , Sistemas de Apoio a Decisões Clínicas , Indicadores Básicos de Saúde , Equipe de Respostas Rápidas de Hospitais , Ressuscitação , Idoso , Estudos de Viabilidade , Feminino , Hospitalização , Humanos , Masculino , Sistemas de Registro de Ordens Médicas , Pessoa de Meia-Idade , Sistemas de Identificação de Pacientes , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Sinais Vitais
16.
Circ Cardiovasc Interv ; 5(2): 220-6, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22456027

RESUMO

BACKGROUND: Clinical outcomes after stent placement in patients with a history of metal allergy remain incompletely understood. We performed a single-center retrospective study to evaluate such outcomes. METHODS AND RESULTS: Twenty-nine allergic patients who underwent coronary stent implantation were compared with a nonallergic group (n=250) matched for demographics and a propensity score for allergy to metal. Hypersensitivity to nickel was reported in 26 of 29 and chromium in 9 of 29. Patch testing performed in 11 of 29 patients was positive in all. Comparing allergy versus control subjects, there were no differences in number of segments treated (1.4±0.7 versus 1.5±0.7), stents placed (1.7±1.1 versus 1.6±0.9), and frequency of drug-eluting stent usage (52% versus 60%). In-hospital death (0% versus 0%), myocardial infarction (MI, 4% versus 3%, P=0.27), and 30-day death (3% versus 0%, P=0.53) and MI (3% versus 4%, P=0.71) were statistically similar. There were no differences in 4-year death (12% versus 13%), target lesion revascularization (TLR, 13 versus 17%, P=0.54), or death/MI/TLR (24% versus 34%, P=0.20). Clinically driven repeat angiography in 12 of 29 allergy patients revealed binary restenosis rates of 27% in bare metal stents and 0% in drug-eluting stents, with mean diameter in-stent restenosis of 36% and 8%, respectively. There was no change in circulating eosinophil and lymphocyte counts after stenting in the allergy group (0.19-0.20, P=0.67, and 1.90-1.79, P=0.59, respectively). CONCLUSIONS: A history of metal allergy was not associated with adverse early or late outcomes in this single-center study.


Assuntos
Implante de Prótese Vascular , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/patologia , Hipersensibilidade/complicações , Metais/imunologia , Idoso , Alérgenos/efeitos adversos , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/mortalidade , Vasos Coronários/efeitos dos fármacos , Vasos Coronários/cirurgia , Stents Farmacológicos , Feminino , Humanos , Hipersensibilidade/epidemiologia , Hipersensibilidade/mortalidade , Masculino , Metais/efeitos adversos , Pessoa de Meia-Idade , Revascularização Miocárdica/estatística & dados numéricos , Estudos Retrospectivos , Testes Cutâneos , Análise de Sobrevida , Resultado do Tratamento
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