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Dao TNP, Dang HNT, Pham MTK, Nguyen HT, Tran Chi C, Le MV. Prognosticating global functional outcome in the recurrent ischemic stroke using baseline clinical and pre-clinical features: A machine learning study. J Eval Clin Pract 2024. [PMID: 39031001 DOI: 10.1111/jep.14100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/16/2024] [Accepted: 07/07/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND AND PURPOSE Recurrent ischemic stroke (RIS) induces additional functional limitations in patients. Prognosticating globally functional outcome (GFO) in RIS patients is thereby important to plan a suitable rehabilitation programme. This study sought to investigate the ability of baseline features for classifying the patients with and without improving GFO (task 1) and identifying patients with poor GFO (task 2) at the third month after discharging from RIS. METHODS A total of 86 RIS patients were recruited and divided into the training set and testing set (50:50). The clinical and pre-clinical data were recorded. The outcome was the changes in Modified Rankin Scale (mRS) (task 1) and the mRS score at the third month (mRS 0-2: good GFO, mRS >2: poor GFO) (task 2). The permutation importance ranking method selected features. Four algorithms were trained on the training set with five-fold cross-validation. The best model was tested on the testing set. RESULTS In task 1, the support vector machine (SVM) model outperformed the other models, with the high performance matrix on the training set (sensitivity = 0.80; specificity = 1.00) and the testing set (sensitivity = 0.80; specificity = 0.95). In task 2, the SVM model with selected features also performed well on both datasets (training set: sensitivity = 0.76; specificity = 0.92; testing set: sensitivity = 0.72; specificity = 0.88). CONCLUSION A machine learning model could be used to classify GFO responses to treatment and identify the third-month poor GFO in RIS patients, supporting physicians in clinical practice.
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Affiliation(s)
- Tran Nhat Phong Dao
- Faculty of Traditional Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Can Tho Traditional Medicine Hospital, Can Tho, Vietnam
| | | | - My Thi Kim Pham
- Department of Cardiac Surgery, Can Tho Central General Hospital, Can Tho, Vietnam
| | - Hien Thi Nguyen
- Department of Nutrition and Food Safety, Faculty of Public Health, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Cuong Tran Chi
- Can Tho Stroke International Services (S.I.S) General Hospital, Can Tho, Vietnam
| | - Minh Van Le
- Department of Neurology, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Department of Neurology, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam
- Department of Neurology, Can Tho Central General Hospital, Can Tho, Vietnam
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2
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Shariati H, Sanei H, Pourmoghadas A, Salehizadeh L, Amirpour A. Immediate outcomes of eptifibatide therapy during intracoronary stent implantation. Adv Biomed Res 2016; 5:204. [PMID: 28217642 PMCID: PMC5220753 DOI: 10.4103/2277-9175.196831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 10/15/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The objective of the present study was to assess the major immediate outcomes of eptifibatide therapy during intracoronary stent implantation. MATERIALS AND METHODS In an interventional study, patients undergoing percutaneous coronary intervention (PCI) were randomized into either the eptifibatide (n = 100) or the control (n = 107) group. In each group, demographic and clinical characteristics such as cardiac death, stent thrombosis (ST), myocardial infarction (MI), rates of target lesion and vessel revascularization, cerebral vascular accident (CVA), and emergency coronary artery bypass grafting (CABG) were recorded. RESULTS The overall rates of major adverse events such as mortality, Stent thrombosis (ST), Myocardial Infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), CVA, and emergency CABG within 24 h after stent implantation were low and comparable between the two groups; P > 0.05 considered significant for all comparisons. CONCLUSION There were no statistical differences between the clinical outcomes of groups administered with single-dose intracoronary eptifibatide and control groups among patients undergoing PCI during stent implantation.
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Affiliation(s)
- Hooman Shariati
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Sanei
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Pourmoghadas
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Salehizadeh
- Interventional Cardiologist, Chamran Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afshin Amirpour
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Mahmoudi M, Delhaye C, Wakabayashi K, Torguson R, Xue Z, Suddath WO, Satler LF, Kent KM, Pichard AD, Waksman R. Integrilin in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. J Interv Cardiol 2011; 24:351-6. [PMID: 21426398 DOI: 10.1111/j.1540-8183.2011.00632.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The adjunctive use of eptifibatide in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) remains controversial. We therefore set out to determine the safety and efficacy of eptifibatide in this population. METHODS The study comprised 857 consecutive patients who underwent primary PCI for STEMI at the Washington Hospital Center. Three hundred eighteen patients also received adjunctive therapy with eptifibatide. Patients who had received thrombolysis prior to undergoing cardiac catheterization were excluded. The primary end-point was all-cause mortality and the composite of all-cause mortality or Q-wave MI. The primary safety end-point was the rate of thrombolysis in myocardial infarction (TIMI) major bleeding. RESULTS The eptifibatide group was younger, had a higher body mass index, and a lower proportion of patients with systemic hypertension, diabetes mellitus, previous history of ischemic heart disease, coronary revascularization, and congestive heart failure. This cohort also used bivalirudin less often (23.3% vs. 72%; P < 0.001). Following multivariable analysis, the eptifibatide group had a significantly lower rate of all-cause mortality (hazard ratio 0.55; 95% confidence interval 0.34-0.89; P = 0.01) and the composite of all-cause mortality or Q-wave MI (hazard ratio 0.59; 95% confidence interval 0.37-0.95; P = 0.03) at 6 months. The rate of TIMI major bleeding was similar in both groups (hazard ratio 0.54; 95% confidence interval 0.25-1.17; P = 0.12). CONCLUSION The adjunctive use of eptifibatide in patients presenting with STEMI may be associated with improved clinical outcomes. (J Interven Cardiol 2011;24:351-356).
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Affiliation(s)
- Michael Mahmoudi
- Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, DC, USA
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4
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Ottani F, La Vecchia L, De Vita M, Catapano O, Tarantino F, Galvani M. Comparison by meta-analysis of eptifibatide and tirofiban to abciximab in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol 2010; 106:167-174.e1. [PMID: 20598998 DOI: 10.1016/j.amjcard.2010.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 03/02/2010] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
Adjunctive therapy with abciximab during primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI) determines a better short-term outcome compared to placebo. Tirofiban and eptifibatide represent a valid option with lower cost, but these have been less studied. The aim of the present study was to combine all randomized trials and registries to demonstrate the noninferiority of tirofiban and eptifibatide compared to abciximab in patients with STEMI treated with PPCI. We identified 6 randomized trials and 4 registries. Overall, 4,653 received small molecules and 2,696 abciximab, and the rate of combined death and nonfatal reinfarction did not differ (4.6% vs 4.5%, odds ratio 0.99, 95% confidence interval [CI] 0.78 to 1.27, p = 0.95) up to 30 days of follow-up, with an absolute difference of 0.1% (95% CI -1.06 to 0.8). Because the noninferiority limit was set at +1.5%, and because the upper point estimate (0.8%) of the 95% CI did not cross the prespecified limit, the noninferiority of the small molecules was documented. In-hospital major bleeding was also similar (8.8% vs 6.1%, odds ratio 0.92, 95% CI 0.75 to 1.13, p = 0.43). Sensitivity analysis comparing randomized trials to registries and tirofiban or eptifibatide to abciximab did not show any significant differences. In conclusion, our results documented noninferiority of "small molecules" compared to abciximab and, therefore, support their alternative use as adjunctive therapy during PPCI for patients with STEMI.
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Le May MR, Wells GA, Glover CA, So DY, Froeschl M, Marquis JF, O'Brien ER, Turek M, Thomas A, Kass M, Jadhav S, Labinaz M. Primary Percutaneous Coronary Angioplasty With and Without Eptifibatide in ST-Segment Elevation Myocardial Infarction. Circ Cardiovasc Interv 2009; 2:330-8. [DOI: 10.1161/circinterventions.108.847582.108.847582] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background—
Primary percutaneous coronary intervention, if performed promptly, is the preferred strategy to restore flow to the infarct-related artery in patients with ST-segment elevation myocardial infarction. We sought to determine whether eptifibatide, a platelet glycoprotein IIb/IIIa inhibitor, given before catheterization would improve clinical outcomes in patients referred for primary percutaneous coronary intervention.
Methods and Results—
We randomly assigned a total of 400 patients with ST-segment elevation myocardial infarction referred for primary percutaneous coronary intervention to treatment initiated before cardiac catheterization, with either heparin plus eptifibatide (201 patients) or heparin alone (199 patients), in addition to oral aspirin (160 mg) and high-dose clopidogrel (600 mg). The primary end point was a composite of death from any cause, recurrent myocardial infarction, or recurrent severe ischemia during the first 30 days after randomization. At 30 days, the primary end point was reached by 13 patients (6.47%) assigned to heparin plus eptifibatide and by 11 patients (5.53%) assigned to heparin alone (relative risk, 1.18; 95% CI, 0.52 to 2.70;
P
=0.69). The rates of major or minor bleeding were higher in patients assigned to heparin plus eptifibatide than that in patients assigned to heparin alone (22.4% versus 14.6%; relative risk, 1.69; 95% CI, 1.01 to 2.83;
P
=0.04).
Conclusions—
In patients pretreated with high-dose clopidogrel who were referred for primary PCI, treatment with heparin plus eptifibatide, when compared with heparin alone, did not improve clinical outcomes and was associated with more bleeding complications.
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Affiliation(s)
- Michel R. Le May
- From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
| | - George A. Wells
- From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
| | - Chris A. Glover
- From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
| | - Derek Y. So
- From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
| | - Michael Froeschl
- From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
| | - Jean-François Marquis
- From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
| | - Edward R. O'Brien
- From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
| | - Michele Turek
- From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
| | - Allyson Thomas
- From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
| | - Malek Kass
- From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
| | - Sachin Jadhav
- From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
| | - Marino Labinaz
- From the University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
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Gurm HS, Tamhane U, Meier P, Grossman PM, Chetcuti S, Bates ER. A comparison of abciximab and small-molecule glycoprotein IIb/IIIa inhibitors in patients undergoing primary percutaneous coronary intervention: a meta-analysis of contemporary randomized controlled trials. Circ Cardiovasc Interv 2009; 2:230-6. [PMID: 20031720 DOI: 10.1161/circinterventions.108.847996] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Current guidelines recommend abciximab as the preferred agent for patients undergoing primary percutaneous coronary intervention, yet small-molecule glycoprotein IIb/IIIa inhibitors are more commonly used in clinical practice. The objective of our meta-analysis was to evaluate for differences in clinical outcome between small-molecule glycoprotein IIb/IIIa inhibitors and abciximab in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. METHODS AND RESULTS Five randomized trials (n=2138 patients) comparing tirofiban or eptifibatide with abciximab as an adjunctive therapy to primary percutaneous coronary intervention were included in this meta-analysis. Summary odds ratios (ORs) for 30-day death, reinfarction, and major bleeding were calculated using random- and fixed-effect models. There were no differences in 30-day mortality (1.9% for small molecule versus 2.3% for abciximab; OR, 0.84; 95% CI, 0.46 to 1.55; P=0.58), reinfarction (1.3% versus 1.2%; OR, 1.22; 95% CI, 0.51 to 2.91; P=0.69), or major bleeding (1.7% versus 1.3%; OR, 1.21; 95% CI, 0.58 to 2.49; P=0.61) between the 2 adjunctive strategies. Similarly, there was no significant difference in the incidence of death (3.9% versus 5%; OR, 0.77; 95% CI, 0.41 to 1.46; P=0.43) or reinfarction on follow-up at 8 months between small-molecule glycoprotein IIb/IIIa inhibitors and abciximab. CONCLUSIONS In patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, no difference in outcome could be identified in patients treated with small-molecule glycoprotein IIb/IIIa inhibitor or abciximab.
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Affiliation(s)
- Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-5853, USA.
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Tamhane UU, Gurm HS. The chimeric monoclonal antibody abciximab: a systematic review of its safety in contemporary practice. Expert Opin Drug Saf 2008; 7:809-19. [DOI: 10.1517/14740330802500353] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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8
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GP IIb/IIIa inhibitors during primary percutaneous coronary intervention for STEMI: New trial and registry data. Curr Cardiol Rep 2008; 10:424-30. [DOI: 10.1007/s11886-008-0066-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Moon SJ, Yoon HJ, Her SH, Lee JM, An HJ, Lee YJ, Jin SW. Hemorrhagic pericarditis with cardiac tamponade after percutaneous coronary intervention associated with the use of abciximab. Korean J Intern Med 2008; 23:156-60. [PMID: 18787370 PMCID: PMC2686964 DOI: 10.3904/kjim.2008.23.3.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Glycoprotein (GP) IIb/IIIa inhibitors, such as abciximab, are used as adjunctive therapy for percutaneous coronary intervention (PCI) in high-risk non-ST-elevation myocardial infarction (NSTEMI) and in ST-elevation myocardial infarction (STEMI), although their effects when used for STEMI are less clear. As the use of GP IIb/IIIa inhibitors becomes more widespread, determining the risks associated with them becomes more important. The major risks associated with the use of GP IIb/IIIa inhibitors are the potential for major bleeding and thrombocytopenia. This is the first reported case in Korea of hemorrhagic pericarditis resulting in cardiac tamponade associated with the use of abciximab, a commonly used GP Ilb/IIa inhibitor, following PCI.
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Affiliation(s)
- Su-Jin Moon
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hee-Jeoung Yoon
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung-Ho Her
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jong-Min Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ho-Jung An
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yune-Jeong Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seung-Won Jin
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Moliterno DJ, Ziada KM. The Safety and Efficacy of Glycoprotein IIb/IIIa Inhibitors for Primary Angioplasty. J Am Coll Cardiol 2008; 51:536-7. [DOI: 10.1016/j.jacc.2007.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 10/02/2007] [Indexed: 10/22/2022]
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Tiemann O. Variations in hospitalisation costs for acute myocardial infarction - a comparison across Europe. HEALTH ECONOMICS 2008; 17:S33-S45. [PMID: 18186036 DOI: 10.1002/hec.1322] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The aim of this study was to determine whether between-country variations in hospital costs are larger than within-country variations and, furthermore, to explore reasons for this variability. For this purpose, we chose the primary treatment of patients with acute myocardial infarction (AMI) as an episode of care. We obtained hospitalisation costs and reimbursement rates from 45 hospitals in nine different EU member states (i.e. Denmark, England, France, Germany, Hungary, Italy, Netherlands, Poland, and Spain) for the year 2005. To further analyse the variations in hospital costs, we employed a hierarchical random effects model based on treatment and hospital characteristics and using purchasing power parities (PPPs) as a proxy for country-specific price levels. The between-country standard error was estimated at 2473 euros, whereas the within-country standard error was estimated at 1242 euros. Our regression analysis showed that percutaneous coronary intervention was associated with significantly increased hospitals costs compared to other treatment strategies. We were able to distinguish between three groups of countries with different cost levels based on the number of hospitals that were able to provide these services (i.e. percutaneous transluminal coronary angioplasty (PTCA) with intracoronary stenting). Excluding Hungary, Poland, and Spain, where none of the participating hospitals were able to provide these procedures, the between-country standard error decreased to 1632 euros, whereas the within-country standard error increased to 1416 euros. Finally, we observed exogenous price-level effects between countries and within countries for hospitals located in urban areas.
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Affiliation(s)
- Oliver Tiemann
- Department of Health Care Management, Berlin University of Technology, Germany.
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