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Kavsak PA, Clark L, Arnoldo S, Lou A, Shea JL, Eintracht S, Lyon AW, Bhayana V, Thorlacius L, Raizman JE, Tsui A, Djiana R, Chen M, Huang Y, Haider A, Booth RA, McCudden C, Yip PM, Beriault D, Blank D, Fung AWS, Taher J, St-Cyr J, Sharif S, Belley-Cote E, Abramson BL, Friedman SM, Cox JL, Sivilotti MLA, Chen-Tournoux A, McLaren J, Mak S, Thiruganasambandamoorthy V, Scheuermeyer F, Humphries KH, Worster A, Ko D, Aakre KM, Mills NL, Jaffe AS. Imprecision of high-sensitivity cardiac troponin assays at the female 99th-percentile. Clin Biochem 2024; 125:110731. [PMID: 38360198 DOI: 10.1016/j.clinbiochem.2024.110731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND An analytical benchmark for high-sensitivity cardiac troponin (hs-cTn) assays is to achieve a coefficient of variation (CV) of ≤ 10.0 % at the 99th percentile upper reference limit (URL) used for the diagnosis of myocardial infarction. Few prospective multicenter studies have evaluated assay imprecision and none have determined precision at the female URL which is lower than the male URL for all cardiac troponin assays. METHODS Human serum and plasma matrix samples were constructed to yield hs-cTn concentrations near the female URLs for the Abbott, Beckman, Roche, and Siemens hs-cTn assays. These materials were sent (on dry ice) to 35 Canadian hospital laboratories (n = 64 instruments evaluated) participating in a larger clinical trial, with instructions for storage, handling, and monthly testing over one year. The mean concentration, standard deviation, and CV for each instrument type and an overall pooled CV for each manufacturer were calculated. RESULTS The CVs for all individual instruments and overall were ≤ 10.0 % for two manufacturers (Abbott CVpooled = 6.3 % and Beckman CVpooled = 7.0 %). One of four Siemens Atellica instruments yielded a CV > 10.0 % (CVpooled = 7.7 %), whereas 15 of 41 Roche instruments yielded CVs > 10.0 % at the female URL of 9 ng/L used worldwide (6 cobas e411, 1 cobas e601, 4 cobas e602, and 4 cobas e801) (CVpooled = 11.7 %). Four Roche instruments also yielded CVs > 10.0 % near the female URL of 14 ng/L used in the United States (CVpooled = 8.5 %). CONCLUSIONS The number of instruments achieving a CV ≤ 10.0 % at the female 99th-percentile URL varies by manufacturer and by instrument. Monitoring assay precision at the female URL is necessary for some assays to ensure optimal use of this threshold in clinical practice.
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Affiliation(s)
| | | | | | - Amy Lou
- Dalhousie University, Halifax, NS, Canada
| | | | | | | | | | | | | | | | | | - Michael Chen
- University of British Columbia, Vancouver, BC, Canada
| | - Yun Huang
- Queen's University, Kingston, ON, Canada
| | - Ali Haider
- Queen's University, Kingston, ON, Canada
| | | | | | - Paul M Yip
- University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dennis Ko
- University of Toronto, Toronto, ON, Canada
| | - Kristin M Aakre
- Institute of Clinical Science, University of Bergen, Bergen, Norway; Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Allan S Jaffe
- Mayo Clinic and Medical Center, Rochester, MN, United States
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2
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Théberge ET, Vikulova DN, Pimstone SN, Brunham LR, Humphries KH, Sedlak TL. The Importance of Nontraditional and Sex-Specific Risk Factors in Young Women With Vasomotor Nonobstructive vs Obstructive Coronary Syndromes. CJC Open 2024; 6:279-291. [PMID: 38487074 PMCID: PMC10935675 DOI: 10.1016/j.cjco.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/26/2023] [Indexed: 03/17/2024] Open
Abstract
Background Heart disease is the leading cause of premature death for women in Canada. Ischemic heart disease is categorized as myocardial infarction (MI) with no obstructive coronary artery disease (MINOCA), ischemia with no obstructive coronary arteries (INOCA), and atherosclerotic obstructive coronary artery disease (CAD) with MI (MI-CAD) or without MI (non-MI-CAD). This study aims to study the prevalence of traditional and nontraditional ischemic heart disease risk factors and their relationships with (M)INOCA, compared to MI-CAD and non-MI-CAD in young women. Methods This study investigated women who presented with premature (at age ≤ 55 years) vasomotor entities of (M)INOCA or obstructive CAD confirmed by coronary angiography, who are currently enrolled in either the Leslie Diamond Women's Heart Health Clinic Registry (WHC) or the Study to Avoid Cardiovascular Events in British Columbia (SAVEBC). Univariable and multivariable regression models were applied to investigate associations of risk factors with odds of (M)INOCA, MI-CAD, and non-MI-CAD. Results A total of 254 women enrolled between 2015 and 2022 were analyzed, as follows: 77 with INOCA and 37 with MINOCA from the registry, and 66 with non-MI-CAD and 74 with MI-CAD from the study. Regression analyses demonstrated that migraines and preeclampsia or gestational hypertension were the most significant risk factors, with a higher likelihood of being associated with premature (M)INOCA, relative to obstructive CAD. Conversely, the presence of diabetes and a current or previous smoking history had the highest likelihood of being associated with premature CAD. Conclusions The risk factor profiles of patients with premature (M)INOCA, compared to obstructive CAD, have significant differences.
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Affiliation(s)
| | - Diana N. Vikulova
- University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Simon N. Pimstone
- University of British Columbia, Vancouver, British Columbia, Canada
- University of British Columbia Hospital, Vancouver, British Columbia, Canada
| | - Liam R. Brunham
- University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | | | - Tara L. Sedlak
- University of British Columbia, Vancouver, British Columbia, Canada
- Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
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3
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Iatan I, Guan M, Humphries KH, Yeoh E, Mancini GBJ. Atherosclerotic Coronary Plaque Regression and Risk of Adverse Cardiovascular Events: A Systematic Review and Updated Meta-Regression Analysis. JAMA Cardiol 2023; 8:937-945. [PMID: 37647074 PMCID: PMC10469293 DOI: 10.1001/jamacardio.2023.2731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 07/08/2023] [Indexed: 09/01/2023]
Abstract
Importance The association between changes in atherosclerotic plaque induced by lipid-lowering therapies (LLTs) and reduction in major adverse cardiovascular events (MACEs) remains controversial. Objective To evaluate the association between coronary plaque regression assessed by intravascular ultrasound (IVUS) and MACEs. Data Sources A comprehensive, systematic search of publications in PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science was performed. Study Selection Clinical prospective studies of LLTs reporting change in percent atheroma volume (PAV) assessed by IVUS and describing MACE components were selected. Data Extraction and Synthesis Reporting was performed in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The association between mean change in PAV and MACEs was analyzed by meta-regression using mixed-effects, 2-level binomial logistic regression models, unadjusted and adjusted for clinical covariates, including mean age, baseline PAV, baseline low-density lipoprotein cholesterol level, and study duration. Main Outcome and Measures Mean PAV change and MACE in intervention and comparator arms were assessed in an updated systematic review and meta-regression analysis of IVUS trials of LLTs that also reported MACEs. Results This meta-analysis included 23 studies published between July 2001 and July 2022, including 7407 patients and trial durations ranging from 11 to 104 weeks. Mean (SD) patient age ranged from 55.8 (9.8) to 70.2 (7.6) years, and the number of male patients from 245 of 507 (48.3%) to 24 of 26 (92.3%). Change in PAV across 46 study arms ranged from -5.6% to 3.1%. The number of MACEs ranged from 0 to 72 per study arm (17 groups [37%] reported no events, 9 [20%] reported 1-2 events, and 20 [43%] reported ≥3 events). In unadjusted analysis, a 1% decrease in mean PAV was associated with 17% reduced odds of MACEs (unadjusted OR, 0.83; 95% CI, 0.71-0.98; P = .03), and with a 14% reduction in MACEs in adjusted analysis (adjusted OR, 0.86; 95% CI, 0.75-1.00; P = .050). Further adjustment for cardiovascular risk factors showed a 19% reduced risk (adjusted OR, 0.81; 95% CI, 0.68-0.96; P = .01) per 1% decrease in PAV. A 1% reduction of PAV change between intervention and comparator arms within studies was also associated with a significant 25% reduction in MACEs (OR, 0.75; 95% CI, 0.56-1.00; P = .046). Conclusions and Relevance In this meta-analysis, regression of atherosclerotic plaque by 1% was associated with a 25% reduction in the odds of MACEs. These findings suggest that change in PAV could be a surrogate marker for MACEs, but given the heterogeneity in the outcomes, additional data are needed.
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Affiliation(s)
- Iulia Iatan
- Centre for Heart Lung Innovation, Department of Medicine, St Paul’s Hospital, Providence Health Care, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meijiao Guan
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Karin H. Humphries
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Eunice Yeoh
- Division of Cardiology, Centre for Cardiovascular Innovation, Cardiovascular Imaging Research Core Laboratory, University of British Columbia, Vancouver, British Columbia, Canada
| | - G. B. John Mancini
- Division of Cardiology, Centre for Cardiovascular Innovation, Cardiovascular Imaging Research Core Laboratory, University of British Columbia, Vancouver, British Columbia, Canada
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4
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Kavsak PA, Clark L, Arnoldo S, Lou A, Shea JL, Eintracht S, Lyon AW, Bhayana V, Thorlacius L, Raizman JE, Tsui AKY, Djiana R, Chen M, Huang Y, Booth RA, McCudden C, Lavoie J, Beriault DR, Blank DW, Fung AWS, Hoffman B, Taher J, St-Cyr J, Yip PM, Belley-Cote EP, Abramson BL, Borgundvaag B, Friedman SM, Mak S, McLaren J, Steinhart B, Udell JA, Wijeysundera HC, Atkinson P, Campbell SG, Chandra K, Cox JL, Mulvagh S, Quraishi AUR, Chen-Tournoux A, Clark G, Segal E, Suskin N, Johri AM, Sivilotti MLA, Garuba H, Thiruganasambandamoorthy V, Robinson S, Scheuermeyer F, Humphries KH, Than M, Pickering JW, Worster A, Mills NL, Devereaux PJ, Jaffe AS. Analytic Result Variation for High-Sensitivity Cardiac Troponin: Interpretation and Consequences. Can J Cardiol 2023; 39:947-951. [PMID: 37094710 DOI: 10.1016/j.cjca.2023.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023] Open
Affiliation(s)
| | - Lorna Clark
- McMaster University, Hamilton, Ontario, Canada
| | | | - Amy Lou
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennifer L Shea
- Department of Laboratory Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | | | - Andrew W Lyon
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Joshua E Raizman
- Department of Laboratory Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Albert K Y Tsui
- Department of Laboratory Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | - Michael Chen
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Yun Huang
- Queen's University, Kingston, Ontario, Canada
| | | | | | - Joël Lavoie
- Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | | | | | - Angela W S Fung
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Paul M Yip
- University of Toronto, Toronto, Ontario, Canada
| | - Emilie P Belley-Cote
- McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | | | | | | | - Susanna Mak
- University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | - Jafna L Cox
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | - Eli Segal
- McGill University, Montréal, Québec, Canada
| | | | | | | | | | | | - Simon Robinson
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Martin Than
- Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - John W Pickering
- Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - P J Devereaux
- McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Allan S Jaffe
- Mayo Clinic and Medical Center, Rochester, Minnesota, United States
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5
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Fordyce CB, Grunau BE, Guan M, Hawkins NM, Lee MK, Helmer JS, Wong GC, Humphries KH, Christenson J. Long-term Mortality, Readmission, and Resource Utilization Among Hospital Survivors of Out-of-Hospital Cardiac Arrest. Can J Cardiol 2022; 38:1719-1728. [PMID: 36031166 DOI: 10.1016/j.cjca.2022.08.225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Among patients with out-of-hospital cardiac arrest (OHCA), the influence of pre- and in-hospital factors on long-term survival, readmission, and resource utilization is ill-defined, mainly related to challenges combining disparate data sources. METHODS Adult nontraumatic OHCA from the British Columbia Cardiac Arrest Registry (January 2009 to December 2016) were linked to provincial datasets comprising comorbidities, medications, cardiac procedures, mortality, and hospital admission and discharge. Among hospital-discharge survivors, the 3-year end point of mortality or mortality and all-cause readmission was examined with the use of the Kaplan-Meier method and multivariable Cox regression model for predictors. The use of publicly funded home care and community services within 1 year after discharge also was evaluated. RESULTS Of the 10,674 linked, emergency medical services-treated adult OHCAs, 3230 were admitted to hospital and 1325 survived to hospital discharge. At 3 years after discharge, the estimated Kaplan-Meier survival rate was 84.1% (95% CI 81.7%-86.1%) and freedom from death or all-cause readmission was 31.8% (29.0%-34.7%). After exclusions, 26.6% (n = 315/1186) accessed residential or home care services within 1 year. Independent predictors of long-term outcomes included age and comorbidities, but also favourable arrest characteristics and in-hospital factors such as revascularization or receipt of an intracardiac defibrillator before discharge. CONCLUSIONS Among OHCA hospital survivors, the long-term death or readmission risk persists and is modulated by both pre- and in-hospital factors. However, only 1 in 4 survivors required residential or home care after discharge. These results support efforts to improve care processes to increase survival to hospital discharge.
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Affiliation(s)
- Christopher B Fordyce
- Division of Cardiology, Department of Medicine, Vancouver General Hospital and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada.
| | - Brian E Grunau
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Emergency Health Services, Vancouver, British Columbia, Canada
| | - Meijiao Guan
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Nathaniel M Hawkins
- Division of Cardiology, Department of Medicine, Vancouver General Hospital and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - May K Lee
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Jennie S Helmer
- British Columbia Emergency Health Services, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Graham C Wong
- Division of Cardiology, Department of Medicine, Vancouver General Hospital and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karin H Humphries
- Division of Cardiology, Department of Medicine, Vancouver General Hospital and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Jim Christenson
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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6
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Sathananthan J, Lauck SB, Cairns J, Humphries KH, Natarajan M, Wijeysundera HC, Cohen DJ, Leon MB, Webb JG, Wood DA. Impact of frailty on a minimalist approach and early discharge following TAVI. AsiaIntervention 2022; 8:143-144. [PMID: 36483279 PMCID: PMC9706763 DOI: 10.4244/aij-d-22-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/29/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Lung Innovation, St Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Sandra B Lauck
- Centre for Heart Lung Innovation, St Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - John Cairns
- Centre for Heart Lung Innovation, St Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | | | - Madhu Natarajan
- Division of Cardiology, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - David J Cohen
- Saint Luke's Hospital, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Martin B Leon
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - John G Webb
- Centre for Heart Lung Innovation, St Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - David A Wood
- Centre for Heart Lung Innovation, St Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
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7
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Awad EM, Humphries KH, Grunau BE, Norris CM, Christenson JM. Predictors of neurological outcome after out-of-hospital cardiac arrest: sex-based analysis: do males derive greater benefit from hypothermia management than females? Int J Emerg Med 2022; 15:43. [PMID: 36064329 PMCID: PMC9442968 DOI: 10.1186/s12245-022-00447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Previous studies of the effect of sex on after out-of-hospital cardiac arrest (OHCA) outcomes focused on survival to hospital discharge and 1-month survival. Studies on the effect of sex on neurological function after OHCA are still limited. The objective of this study was to identify the predictors of favorable neurological outcome and to examine the association between sex as a biological variable and favorable neurological outcome OHCA. Methods Retrospective analyses of clustered data from the Resuscitation Outcomes Consortium multi-center randomized controlled trial (2011–2015). We included adults with non-traumatic OHCA and EMS-attended OHCA. We used multilevel logistic regression to examine the association between sex and favorable neurological outcomes (modified Rankin Scale) and to identify the predictors of favorable neurological outcome. Results In total, 22,416 patients were included. Of those, 8109 (36.2%) were females. The multilevel analysis identified the following variables as significant predictors of favorable neurological outcome: younger age, shorter duration of EMS arrival to the scene, arrest in public location, witnessed arrest, bystander CPR, chest compression rate (CCR) of 100–120 compressions per minute, induction of hypothermia, and initial shockable rhythm. Two variables, insertion of an advanced airway and administration of epinephrine, were associated with poor neurological outcome. Our analysis showed that males have higher crude rates of survival with favorable neurological outcome (8.6 vs. 4.9%, p < 0.001). However, the adjusted rate was not significant. Further analyses showed that hypothermia had a significantly greater effect on males than females. Conclusions Males had significantly higher crude rates of survival with favorable neurological outcome. However, the adjusted rate was not statistically significant. Males derived significantly greater benefit from hypothermia management than females, but this can possibly be explained by differences in arrest characteristics or in-hospital treatment. In-depth confirmatory studies on the hypothermia effect size by sex are required.
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Affiliation(s)
- Emad M Awad
- Faculty of Medicine, Experimental Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Room 10117, Vancouver, BC, V5Z 1M9, Canada. .,BC RESURECT: BC Resuscitation Research Collaborative, Vancouver, British Columbia, Canada.
| | - Karin H Humphries
- BC RESURECT: BC Resuscitation Research Collaborative, Vancouver, British Columbia, Canada.,Division of Cardiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Brian E Grunau
- BC RESURECT: BC Resuscitation Research Collaborative, Vancouver, British Columbia, Canada.,Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen M Norris
- Faculties of Nursing, Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jim M Christenson
- BC RESURECT: BC Resuscitation Research Collaborative, Vancouver, British Columbia, Canada.,Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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8
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Islam S, Dover DC, Daniele P, Hawkins NM, Humphries KH, Kaul P, Sandhu RK. Sex Differences in the Management of Oral Anticoagulation and Outcomes for Emergency Department Presentation of Incident Atrial Fibrillation. Ann Emerg Med 2022; 80:97-107. [DOI: 10.1016/j.annemergmed.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 11/01/2022]
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9
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Ko DT, Ahmed T, Austin PC, Cantor WJ, Dorian P, Goldfarb M, Gong Y, Graham MM, Gu J, Hawkins NM, Huynh T, Humphries KH, Koh M, Lamarche Y, Lambert LJ, Lawler PR, Légaré JF, Ly HQ, Qiu F, Quraishi AUR, So DY, Welsh RC, Wijeysundera HC, Wong G, Yan AT, Gurevich Y. Development of Acute Myocardial Infarction Mortality and Readmission Models for Public Reporting on Hospital Performance in Canada. CJC Open 2021; 3:1051-1059. [PMID: 34505045 PMCID: PMC8413230 DOI: 10.1016/j.cjco.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Given changes in the care and outcomes of acute myocardial infarction (AMI) patients over the past several decades, we sought to develop prediction models that could be used to generate accurate risk-adjusted mortality and readmission outcomes for hospitals in current practice across Canada. Methods A Canadian national expert panel was convened to define appropriate AMI patients for reporting and develop prediction models. Preliminary candidate variable evaluation was conducted using Ontario patients hospitalized with a most responsible diagnosis of AMI from April 1, 2015 to March 31, 2018. National data from the Canadian Institute for Health Information was used to develop AMI prediction models. The main outcomes were 30-day all-cause in-hospital mortality and 30-day urgent all-cause readmission. Discrimination of these models (measured by c-statistics) was compared with that of existing Canadian Institute for Health Information models in the same study cohort. Results The AMI mortality model was assessed in 54,240 Ontario AMI patients and 153,523 AMI patients across Canada. We observed a 30-day in-hospital mortality rate of 6.3%, and a 30-day all-cause urgent readmission rate of 10.7% in Canada. The final Canadian AMI mortality model included 12 variables and had a c-statistic of 0.834. For readmission, the model had 13 variables and a c-statistic of 0.679. Discrimination of the new AMI models had higher c-statistics compared with existing models (c-statistic 0.814 for mortality; 0.673 for readmission). Conclusions In this national collaboration, we developed mortality and readmission models that are suitable for profiling performance of hospitals treating AMI patients in Canada.
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Affiliation(s)
- Dennis T Ko
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Tareq Ahmed
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Warren J Cantor
- University of Toronto, Toronto, Ontario, Canada.,Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Paul Dorian
- University of Toronto, Toronto, Ontario, Canada.,Unity Health Toronto, Toronto, Ontario, Canada
| | - Michael Goldfarb
- Azrieli Heart Centre, Jewish General Hospital, Montreal, Quebec, Canada
| | - Yanyan Gong
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Michelle M Graham
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Jing Gu
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Nathaniel M Hawkins
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thao Huynh
- Department of Medicine, Division of Cardiology, McGill University, Montreal, Quebec, Canada
| | - Karin H Humphries
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Vancouver, British Columbia, Canada
| | | | - Yoan Lamarche
- Department of Surgery, Montreal Heart Institute, Montreal Quebec, Canada
| | - Laurie J Lambert
- INESSS, Quebec City, Quebec, Canada.,CADTH, Ottawa, Ontario, Canada
| | - Patrick R Lawler
- University of Toronto, Toronto, Ontario, Canada.,Peter Munk Cardiac Centre, University Healthy Network, Toronto, Ontario, Canada
| | - Jean-Francois Légaré
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Hung Q Ly
- Department of Surgery, Montreal Heart Institute, Montreal Quebec, Canada
| | | | - Ata Ur Rehman Quraishi
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Derek Y So
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert C Welsh
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Harindra C Wijeysundera
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Graham Wong
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, British Columbia, Canada
| | - Andrew T Yan
- University of Toronto, Toronto, Ontario, Canada.,Unity Health Toronto, Toronto, Ontario, Canada
| | - Yana Gurevich
- Canadian Institute for Health Information, Toronto, Ontario, Canada
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10
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Awad EM, Humphries KH, Grunau BE, Christenson JM. Premenopausal-aged females have no neurological outcome advantage after out-of-hospital cardiac arrest: A multilevel analysis of North American populations. Resuscitation 2021; 166:58-65. [PMID: 34271125 DOI: 10.1016/j.resuscitation.2021.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/14/2021] [Accepted: 06/20/2021] [Indexed: 11/28/2022]
Abstract
AIM We investigated the impact of premenopausal age on neurological function at hospital discharge in patients with out-of-hospital cardiac arrest (OHCA). We hypothesized that premenopausal-aged females (18-47 years of age) with OHCA would have a higher probability of survival with favourable neurological function at hospital discharge compared with males of the same age group, older males, and older females (>53 years of age). METHODS Retrospective analyses of data from the Resuscitation Outcomes Consortium multi-center randomized controlled trial (June 2011-May 2015). We included adults with non-traumatic OHCA treated by emergency medical service. We stratified the cohort into four groups by age and sex: premenopausal-aged females (18-47 years of age), older females (≥53 years old), younger males (18-47 years of age), and older male. We used multilevel logistic regression to examine the association between age-sex and favourable neurological outcomes (modified Rankin Scale ≤ 3). RESULTS In total, 23,725 patients were included: 1050 (4.5%) premenopausal females; 1930 (8.1%) younger males; 7569 (31.9%) older females; and 13,176 (55.5%) older males. The multilevel analysis showed no difference in neurological outcome between younger males and younger females (OR 0.95, 95% CI 0.69-1.32, p = 0.75). Both older females (OR 0.36, 95% CI 0. 0.26-0.48, p < 0.001) and older males (OR 0.52, 95% CI 0.39-0.69, p < 0.001) had a significantly lower odds of favourable neurological outcome than younger females. Among all groups, older females had the worst outcomes. CONCLUSIONS We did not detect an association between premenopausal age and survival with good neurological outcome, suggesting females sex hormones do not impact OHCA outcomes. Our findings are not in line with results from other studies. Studies that rigorously evaluate menopausal status are required to definitively assess the impact of female sex hormones on outcomes.
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Affiliation(s)
- Emad M Awad
- Faculty of Medicine, Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.
| | - Karin H Humphries
- Division of Cardiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Brian E Grunau
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Jim M Christenson
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
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11
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Rayner-Hartley E, Wong GC, Fayowski C, Cairns JA, Singer J, Lee T, Sedlak T, Humphries KH, Perry-Arnesen M, Mackay M, Fordyce CB. Impact of regionalizing ST-elevation myocardial infarction care on sex differences in reperfusion times and clinical outcomes. Clin Cardiol 2021; 44:1113-1119. [PMID: 34101211 PMCID: PMC8364721 DOI: 10.1002/clc.23658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Women with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention historically experience worse in-hospital outcomes compared to men. HYPOTHESIS Implementation of a regional STEMI system will reduce care gaps in reperfusion times and in-hospital outcomes between women and men. METHODS 1928 patients (413 women, 21.4%) presented with an acute STEMI between June 2007 and March 2016. The population was divided into an early cohort (n = 728 patients, 2007-May 2011), and a late cohort (n = 1200 patients, June 2011-2016). The primary endpoints evaluated were reperfusion times and in-hospital outcomes. RESULTS Compared to men, women experienced significant delays in first medical contact (FMC) to arrival at the emergency room (26.0 vs. 22.0 min, p < 0.001) and FMC-to-device (109 vs. 101 min p = 0.001). Women had higher incidences of post-PCI heart failure and death compared to men (p < 0.05). Following multivariable adjustment, no mortality difference was observed for women versus men (adjusted OR; 0.82; 95% confidence interval [CI], 0.51-1.34; p = 0.433) or for early versus late cohorts (adjusted OR; 1.04; 95% CI, 0.68-1.60; p = 0.856). CONCLUSION Following STEMI regionalization, women continued to experience significantly longer reperfusion times, although there was no difference in adjusted mortality. These results highlight the ongoing disparity of STEMI care between women and men, and suggest that regionalization alone is insufficient to close sex-based care gaps.
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Affiliation(s)
- Erin Rayner-Hartley
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Royal Columbian Hospital, Division of Cardiology, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Graham C Wong
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Cassandra Fayowski
- Division of General Internal Medicine, Western University, London, Ontario, Canada
| | - John A Cairns
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara Sedlak
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michele Perry-Arnesen
- Royal Columbian Hospital, Division of Cardiology, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Martha Mackay
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Namdarimoghaddam P, Fowokan A, Humphries KH, Mancini GBJ, Lear S. Association of "hypertriglyceridemic waist" with increased 5-year risk of subclinical atherosclerosis in a multi-ethnic population: a prospective cohort study. BMC Cardiovasc Disord 2021; 21:63. [PMID: 33530949 PMCID: PMC7851930 DOI: 10.1186/s12872-021-01882-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/24/2021] [Indexed: 12/17/2022] Open
Abstract
Background Hypertriglyceridemic waist (HTGW), which incorporates measures of waist circumference and levels of triglyceride in blood, could act as an early-stage predictor to identify the individuals at high-risk for subclinical atherosclerosis. Previous studies have explored the cross-sectional association between HTGW and atherosclerosis; however, understanding how this association might change over time is necessary. This study will assess the association between HTGW with 5-year subclinical carotid atherosclerosis. Methods 517 participants of Aboriginal, Chinese, European, and South Asian ethnicities were examined for baseline HTGW and 5-year indices of subclinical atherosclerosis (intima media thickness (mm), total area (mm2), and plaque presence). Family history of cardiovascular disease, sociodemographic measures (age, sex, ethnicity, income level, maximum education), and traditional risk factors (systolic blood pressure, smoking status, total cholesterol, high-density lipoprotein cholesterol, body mass index) were incorporated into the models of association. These models used multiple linear regression and logistic regression. Results Baseline HTGW phenotype is a statistically significant and clinically meaningful predictor of 5-year intima media thickness (β = 0.08 [0.04, 0.11], p < 0.001), total area (β = 0.20 [0.07, 0.33], p = 0.002), and plaque presence (OR = 2.17 [1.13, 4.19], p = 0.02) compared to the non-HTGW group independent of sociodemographic factors and family history. However, this association is no longer significant after adjusting for the traditional risk factors of atherosclerosis (p = 0.27, p = 0.45, p = 0.66, respectively). Moreover, change in status of HTGW phenotype does not correlate with change in indices of atherosclerosis over 5 years. Conclusions Our results suggest that when the traditional risk factors of atherosclerosis are known, HTGW may not offer additional value as a predictor of subclinical atherosclerosis progression over 5 years.
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Affiliation(s)
| | - Adeleke Fowokan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Karin H Humphries
- BC Centre for Improved Cardiovascular Health (ICVHealth) at Centre for Health Evaluation and Outcome Sciences (CHEOS), Vancouver, BC, V6Z 2K5, Canada.,Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - G B John Mancini
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Scott Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.,Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.,Division of Cardiology, Providence Health Care, Vancouver, BC, V6Z 1Y6, Canada
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13
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Zhao Y, Izadnegahdar M, Lee MK, Kavsak PA, Singer J, Scheuermeyer F, Udell JA, Robinson S, Norris CM, Lyon AW, Pilote L, Cox J, Hassan A, Rychtera A, Johnson D, Mills NL, Christenson J, Humphries KH. High-Sensitivity Cardiac Troponin-Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women (CODE-MI): Rationale and design for a multicenter, stepped-wedge, cluster-randomized trial. Am Heart J 2020; 229:18-28. [PMID: 32916606 DOI: 10.1016/j.ahj.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
Despite evidence that high-sensitivity cardiac troponin (hs-cTn) levels in women are lower than in men, a single threshold based on the 99th percentile upper reference limit of the overall reference population is commonly used to diagnose myocardial infarction in clinical practice. This trial aims to determine whether the use of a lower female-specific hs-cTn threshold would improve the diagnosis, treatment, and outcomes of women presenting to the emergency department with symptoms suggestive of myocardial ischemia. METHODS/DESIGN: CODE-MI (hs-cTn-Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women) is a multicenter, stepped-wedge, cluster-randomized trial of 30 secondary and tertiary care hospitals across 8 Canadian provinces, with the unit of randomization being the hospital. All adults (≥20 years of age) presenting to the emergency department with symptoms suggestive of myocardial ischemia and at least 1 hs-cTn test are eligible for inclusion. Over five, 5-month intervals, hospitals will be randomized to implement lower female hs-cTn thresholds according to the assay being used at each site. Men will continue to be assessed using the overall thresholds throughout. Women with a peak hs-cTn value between the female-specific and the overall thresholds will form our primary cohort. The primary outcome, a 1-year composite of all-cause mortality or readmission for nonfatal myocardial infarction, incident heart failure, or emergent/urgent coronary revascularization, will be compared before and after the implementation of female thresholds using mixed-effects logistic regression models. The cohort and outcomes will be obtained from routinely collected administrative data. The trial is designed to detect a 20% relative risk difference in the primary outcome, or a 2.2% absolute difference, with 82% power. CONCLUSIONS: This pragmatic trial will assess whether adopting lower female hs-cTn thresholds leads to appropriate assessment of women with symptoms suggestive of myocardial infarction, thereby improving treatment and outcomes.
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14
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Sathananthan J, Webb JG, Lauck SB, Cairns J, Humphries KH, Nazif T, Thourani VH, Cohen DJ, Leon MB, Wood DA. Impact of Local Anesthesia Only Versus Procedural Sedation Using the Vancouver Clinical Pathway for TAVR: Insights From the 3M TAVR Study. JACC Cardiovasc Interv 2020; 12:1000-1001. [PMID: 31122345 DOI: 10.1016/j.jcin.2019.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 11/29/2022]
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15
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Miller KJ, Park JE, Ramanathan K, Abel J, Zhao Y, Mamdani A, Pak M, Fung A, Gao M, Humphries KH. Examining Coronary Revascularization Practice Patterns for Diabetics: Perceived Barriers, Facilitators, and Implications for Knowledge Translation. Can J Cardiol 2020; 36:1236-1243. [PMID: 32621887 DOI: 10.1016/j.cjca.2019.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/25/2019] [Accepted: 11/07/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The FREEDOM trial provided robust evidence that coronary artery bypass grafting (CABG) was superior to percutaneous coronary intervention (PCI) for coronary revascularization in patients with diabetes mellitus (DM) and multivessel coronary artery disease (MV-CAD). The present study examined practice pattern changes and perceived barriers and facilitators to implementing FREEDOM trial evidence in British Columbia (BC). METHODS Using a population-based database of cardiac procedures in BC, PCI:CABG ratios from 2007-2014 were compared before and after publication of the FREEDOM trial in the 4 tertiary cardiac centres that provided both CABG and PCI. Surveys of barriers and facilitators to implementation of evidence in practice were completed by 57 health care providers (HCPs) attending educational outreach sessions conducted in 2016-17 at 5 tertiary cardiac centres in BC. RESULTS The overall PCI:CABG ratio declined from 1.59 (95% confidence interval [CI] 1.48-1.70, range 1.16-1.86) before publication to 0.88 (95% CI 0.75-1.01, range 0.56-0.82) after publication (P < 0.01). This decline from before to after publication was significant in 3 centres, but not in the fourth centre (from 1.62 to 1.49; P = 0.61). Barriers were identified at the levels of evidence (applicability, credibility), HCP (awareness/knowledge, practice behaviours), patient (knowledge/misconceptions, preferences), and systems (siloing of care, financial disincentives, resource limitations, geography). Facilitators were additional studies/guidelines, education/dissemination, shared decision making, a heart team approach, changes to remuneration models, and increased resources. CONCLUSIONS Following publication of the FREEDOM trial, the proportion of patients with DM and MV-CAD undergoing CABG increased in BC; however, practice patterns varied across cardiac centres. HCPs attributed these practice variations to multilevel barriers and facilitators. Future knowledge translation strategies should be multifaceted and tailored to identified determinants.
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Affiliation(s)
- Kimberly J Miller
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - Julie E Park
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Krishnan Ramanathan
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Abel
- Division of Cardiothoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yinshan Zhao
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Avanish Mamdani
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Melissa Pak
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Anthony Fung
- Division of Cardiothoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Min Gao
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Karin H Humphries
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Lauck SB, Arnold SV, Borregaard B, Sathananthan J, Humphries KH, Baron SJ, Wijeysundera HC, Asgar A, Welsh R, Velianou JL, Webb JG, Wood DA, Cohen DJ. Very Early Changes in Quality of Life After Transcatheter Aortic Valve Replacement: Results From the 3M TAVR Trial. Cardiovasc Revasc Med 2020; 21:1573-1578. [PMID: 32571762 DOI: 10.1016/j.carrev.2020.05.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/29/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with severe, symptomatic aortic stenosis derive substantial 30-day quality of life (QOL) benefit from transcatheter aortic valve replacement (TAVR). Whether the QOL benefit of TAVR emerges earlier is unknown. We used data from the Multimodality, Multidisciplinary but Minimalist (3M) TAVR study to assess early changes in QOL after transfemoral (TF) TAVR. METHODS Health status was assessed at baseline, 2-weeks, 30-days, and 1-year after TAVR using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and Medical Outcomes Study Short-Form 12 (SF-12). The KCCQ overall summary (KCCQ-OS) score (range 0-100; higher scores = better health) was the primary health status outcome. Linear mixed effects models were used to describe trajectories of QOL scores over time. A good outcome was defined as being "alive and well", with a KCCQ-OS score ≥ 60 points with no decrease from baseline ≥10 points. RESULTS A total of 358 patients (87.1%) completed the baseline and at least one follow-up survey. Between baseline and 2-weeks, the KCCQ-OS increased by 21.3 points (95% confidence interval [CI]: 19.3-23.2). This improvement was sustained over time with only slight further improvement between 2-weeks and 1-month (3.4 points; 95% CI: 1.4 to 5.5) and no significant change between 1-month and 1-year (1.9 points; 95% CI: -0.2 to 4.1). Scores for the KCCQ subscales and SF-12 physical and mental component summary scales showed a similar pattern. Most patients (74.4%) were "alive and well" at 2 weeks with similar rates at 1-month and 1-year (79.5% and 77.3%, respectively). CONCLUSIONS Among patients undergoing TF-TAVR, both disease-specific and generic health status improved substantially within the first 2 weeks, with only minimal further improvement thereafter.
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Affiliation(s)
- Sandra B Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, Canada.
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, Canada; Vancouver General Hospital, Vancouver, Canada
| | - Karin H Humphries
- BC Centre for Improved Cardiovascular Health, St. Paul's Hospital, Vancouver, Canada
| | | | | | | | - Robert Welsh
- Mazankowski Alberta Heart Institute, Edmonton, Canada
| | | | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, Canada
| | - David A Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, Canada; Vancouver General Hospital, Vancouver, Canada
| | - David J Cohen
- University of Missouri-Kansas City, Kansas City, MO, USA
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17
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Vikulova DN, Skorniakov IS, Bitoiu B, Brown C, Theberge E, Fordyce CB, Francis GA, Humphries KH, Mancini GJ, Pimstone SN, Brunham LR. Lipid-lowering therapy for primary prevention of premature atherosclerotic coronary artery disease: Eligibility, utilization, target achievement, and predictors of initiation. Am J Prev Cardiol 2020; 2:100036. [PMID: 34327459 PMCID: PMC8315606 DOI: 10.1016/j.ajpc.2020.100036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Despite advances in screening and prevention, rates of premature coronary artery disease (CAD) have been stagnant. The goals of this study were to investigate the barriers to early risk detection and preventive treatment in patients with premature CAD. In particular, we: 1) assessed the performance of the latest versions of major international guidelines in detection of risk of premature CAD and eligibility for preventive treatment; and, 2) investigated real-life utilization of primary prevention with lipid-lowering therapies in these patients. METHODS We included patients in the Study to Avoid cardioVascular Events in British Columbia (SAVE BC), an observational study of patients with premature (males ≤ 50 years, females ≤ 55 years) angiographically confirmed CAD. Eligibility for primary prevention and treatment received were assessed retrospectively based on information recorded prior to or at the index presentation with CAD. RESULTS Of 417 patients (28.1% females) who met the criteria, 94.3% had at least one major cardiovascular risk factor. In the retrospective risk assessment, 41.7%, 61.4%, and 34.3% (p < 0.001) of patients met criteria for initiation of statin therapy, and an additional 13.9%, 8.4%, and 46.8% may be considered for treatment using the American College of Cardiology/American Heart Association, Canadian Cardiovascular Society, and European Society of Cardiology guidelines, respectively. Only 17.1% of patients received statins and 11.0% achieved guideline-recommended lipid goals before presentation. Diabetes and elevated plasma lipid levels were positively associated with treatment initiation, while smoking was associated with non-treatment. CONCLUSIONS The current versions of major guidelines fail to recognize many patients who develop premature CAD as being at risk. The vast majority of these patients, including patients who have guideline-directed indications, do not receive lipid-lowering therapy before presenting with CAD. Our findings highlight the need for more effective screening and prevention strategies for premature CAD.
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Affiliation(s)
- Diana N. Vikulova
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Ilia S. Skorniakov
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Brendon Bitoiu
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Chad Brown
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Emilie Theberge
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | | | - Gordon A. Francis
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Karin H. Humphries
- Centre for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, Canada
| | - G.B. John Mancini
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Simon N. Pimstone
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Liam R. Brunham
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
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18
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Humphries KH, Hawkins N. Sex Differences in Complications and Outcomes of Cardiac Implantable Electronic Devices: Time to Evaluate Our Practice. Can J Cardiol 2019; 36:16-18. [PMID: 31759788 DOI: 10.1016/j.cjca.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Improved Cardiovascular Health, CHÉOS, Vancouver, British Columbia, Canada.
| | - Nathaniel Hawkins
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Vikulova DN, Grubisic M, Zhao Y, Lynch K, Humphries KH, Pimstone SN, Brunham LR. Premature Atherosclerotic Cardiovascular Disease: Trends in Incidence, Risk Factors, and Sex-Related Differences, 2000 to 2016. J Am Heart Assoc 2019; 8:e012178. [PMID: 31280642 PMCID: PMC6662126 DOI: 10.1161/jaha.119.012178] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The incidence of atherosclerotic cardiovascular disease has declined in the past 2 decades. However, these benefits may not extend to young patients. The objective of this work was to assess temporal trends in the incidence, risk profiles, sex-related differences, and outcomes in a contemporary population of young patients presenting with coronary artery disease ( CAD ) in British Columbia, Canada. Methods and Results We used a provincial cardiac registry to identify young patients (men aged <50 years, women aged <55 years), with a first presentation of CAD between 2000 and 2016, who had either ≥50% stenosis of ≥1 coronary arteries on angiography or underwent coronary revascularization. A total of 12 519 patients (30% women) met our inclusion criteria. The incidence of CAD remained stable and was higher for men than women (46-53 versus 18-23 per 100 000). Of patients, 92% had at least one traditional cardiovascular risk factor and 67% had multiple risk factors. The prevalence of diabetes mellitus, obesity, and hypertension increased during the study period and was higher for women. Women had fewer emergent procedures and revascularizations. Mortality rates decreased by 31% between 2000 and 2007, then were stable for the remaining 9 years. Mortality was significantly higher for women aged <45 years compared with men. Conclusions The incidence of premature CAD has not declined, and the prevalence of 3 major cardiovascular risk factors increased between 2000 and 2016. The risk burden and mortality rates were worse for women. These data have important implications for the design of strategies to prevent CAD in young adults.
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Affiliation(s)
- Diana N Vikulova
- 1 Department of Medicine University of British Columbia Vancouver BC Canada.,2 Centre for Heart Lung Innovation University of British Columbia Vancouver BC Canada
| | - Maja Grubisic
- 3 BC Centre for Improved Cardiovascular Health Vancouver BC Canada
| | - Yinshan Zhao
- 3 BC Centre for Improved Cardiovascular Health Vancouver BC Canada
| | - Kelsey Lynch
- 2 Centre for Heart Lung Innovation University of British Columbia Vancouver BC Canada
| | - Karin H Humphries
- 3 BC Centre for Improved Cardiovascular Health Vancouver BC Canada.,4 Center for Health Evaluation and Outcomes Science University of British Columbia Vancouver BC Canada
| | - Simon N Pimstone
- 1 Department of Medicine University of British Columbia Vancouver BC Canada.,2 Centre for Heart Lung Innovation University of British Columbia Vancouver BC Canada
| | - Liam R Brunham
- 1 Department of Medicine University of British Columbia Vancouver BC Canada.,2 Centre for Heart Lung Innovation University of British Columbia Vancouver BC Canada
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20
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Raeisi-Dehkordi H, Amiri M, Humphries KH, Salehi-Abargouei A. The Effect of Canola Oil on Body Weight and Composition: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials. Adv Nutr 2019; 10:419-432. [PMID: 30809634 PMCID: PMC6520036 DOI: 10.1093/advances/nmy108] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/14/2018] [Accepted: 10/31/2018] [Indexed: 01/12/2023] Open
Abstract
A number of clinical trials have examined the effect of canola oil (CO) on body composition in recent years; however, the results have been inconsistent. The present investigation aims to examine the effect of CO on body weight (BW) and body composition using a systematic review and meta-analysis of controlled clinical trials. Online databases including PubMed, Scopus, and Google Scholar were searched up to February, 2018 for randomized controlled clinical trials that examined the effect of CO on anthropometric measures and body composition indexes in adults. The Cochrane Collaboration's tool was used to assess the risk of bias in individual studies. A random-effects model was used to evaluate the effect of CO consumption on several outcomes: BW, body mass index, waist circumference, hip circumference, waist-to-hip ratio, android-to-gynoid ratio, and body lean and fat mass. In total, 25 studies were included in the systematic review. The meta-analysis revealed that CO consumption reduces BW [weighted mean difference (WMD) = -0.30 kg; 95% CI: -0.52, -0.08 kg, P = 0.007; n = 23 effect sizes], particularly in participants with type 2 diabetes (WMD = -0.63 kg; 95% CI: -1.09, -0.17 kg, P = 0.007), in studies with a parallel design (WMD = -0.49 kg; 95% CI: -0.85, -0.14 kg, P = 0.006), in nonfeeding trials (WMD = -0.32 kg; 95% CI: -0.55, -0.09 kg, P = 0.006), and when compared with saturated fat (WMD = -0.40 kg; 95% CI: -0.74, -0.06 kg, P = 0.019). CO consumption did not significantly affect any other anthropometric measures or body fat markers (P > 0.05). Although CO consumption results in a modest decrease in BW, no significant effect was observed on other adiposity indexes. Further well-constructed clinical trials that target BW and body composition as their primary outcomes are needed.
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Affiliation(s)
- Hamidreza Raeisi-Dehkordi
- Nutrition and Food Security Research Center
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojgan Amiri
- Nutrition and Food Security Research Center
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Amin Salehi-Abargouei
- Nutrition and Food Security Research Center
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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21
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Mackay MH, Ratner PA, Veenstra G, Scheuermeyer FX, Grubisic M, Ramanathan K, Murray C, Humphries KH. Racism Is Not a Factor in Door-to-electrocardiogram Times of Patients With Symptoms of Acute Coronary Syndrome: A Prospective, Observational Study. Acad Emerg Med 2019; 26:491-500. [PMID: 30222233 PMCID: PMC6563064 DOI: 10.1111/acem.13569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 12/03/2022]
Abstract
Background Investigators have identified important racial identity/ethnicity‐based differences in some aspects of acute coronary syndrome (ACS) care and outcomes (time to presentation, symptoms, receipt of coronary angiography/revascularization, repeat revascularization, mortality). Patient‐based differences such as pathophysiology and treatment‐seeking behavior account only partly for these outcome differences. We sought to investigate whether there are racial identity/ethnicity‐based variations in the initial emergency department (ED) triage and care of patients with suspected ACS in Canadian hospitals. Methods We prospectively enrolled ED patients with suspected ACS from one university‐affiliated and two community hospitals. Trained research assistants administered a standardized interview to gather data on symptoms, treatment‐seeking patterns, and self‐reported racial/ethnic identity: “white,” South Asian” (SA), “Asian,” or “Other.” Clinical parameters were obtained through chart review. The primary outcome was door‐to‐electrocardiogram (D2ECG) time. ECG times were log‐transformed and two linear regression models, controlling for important demographic, system, and clinical factors, were fit. Results Of 448 participants, 214 (48%) reported white identity, 115 (26%) SA, 83 (19%) Asian, and 36 (8%) “Other.” Asian respondents were younger and more likely to report initial discomfort as “low” and be accompanied by family; respondents identifying as “Other” were more likely to report initial discomfort as “high.” There was no difference in D2ECG time between white participants and all other groups, but there were statistically significant differences by sex: women had longer D2ECG times than men. Exploring more specific racial identities revealed similar findings: no significant differences between the white, SA, Asian, and other groups, while sex (women had 13.4% [95% confidence interval, 0.81%–27.57%] longer D2ECG times) remained statistically significantly different in the adjusted models. Conclusion Although racial/ethnicity‐based differences in aspects of ACS care have been previously identified, we found no differences in the current study of early ED care in a Canadian urban setting. However, female patients experience longer D2ECG times, and this may be a target for process improvements.
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Affiliation(s)
- Martha H. Mackay
- University of British Columbia Vancouver British Columbia Canada
- BC Centre for Improved Cardiovascular Health Vancouver British Columbia Canada
- Centre for Health Evaluation and Outcomes Sciences Vancouver British Columbia Canada
| | - Pamela A. Ratner
- University of British Columbia Vancouver British Columbia Canada
| | - Gerry Veenstra
- University of British Columbia Vancouver British Columbia Canada
| | | | - Maja Grubisic
- BC Centre for Improved Cardiovascular Health Vancouver British Columbia Canada
| | | | - Craig Murray
- Fraser Health Authority Surrey British Columbia Canada
| | - Karin H. Humphries
- University of British Columbia Vancouver British Columbia Canada
- BC Centre for Improved Cardiovascular Health Vancouver British Columbia Canada
- Centre for Health Evaluation and Outcomes Sciences Vancouver British Columbia Canada
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22
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Bhindi R, Guan M, Zhao Y, Humphries KH, Mancini GBJ. Coronary atheroma regression and adverse cardiac events: A systematic review and meta-regression analysis. Atherosclerosis 2019; 284:194-201. [PMID: 30933694 DOI: 10.1016/j.atherosclerosis.2019.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The relationship between plaque regression induced by dyslipidemia therapies and occurrence of major adverse cardiovascular events (MACE) is controversial. We performed a systematic review and meta-regression of dyslipidemia therapy studies reporting MACE and intravascular ultrasound (IVUS) measures of change in coronary atheroma. METHODS Prospective studies of dyslipidemia therapies reporting percent atheroma volume (PAV) measured by IVUS and reporting death, myocardial infarction, stroke, unstable angina or transient ischemic attack (MACE) were included. The association between mean change in PAV and MACE was examined using meta-regression via mixed-effects binomial logistic regression models, unadjusted and adjusted for mean age, baseline PAV, baseline low density lipoprotein-cholesterol and study duration. RESULTS The study included 17 prospective studies published between 2001 and 2018 totaling 6333 patients. Study duration varied from 11 to 104 weeks. Mean change in PAV, across the study arms, ranged from -5.6% to 3.1%. MACE ranged from 0 to 72 events per study arm: 13 study arms (38%) reported no events, 8 (24%) reported 1-2 events and 13 (38%) reported 3 or more events. Meta-regression demonstrated a decline in the odds of MACE associated with reduction in mean PAV: unadjusted odds ratio (OR): 0.78, 95% Confidence Interval (CI): [0.63, 0.96], p = 0.018; adjusted OR: 0.82, 95% CI: [0.70, 0.95], p = 0.011, per 1% decrease in mean PAV. CONCLUSIONS A 1% reduction in mean PAV as induced by dyslipidemia therapies was associated with a 20% reduction in the odds of MACE.
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Affiliation(s)
- Rahul Bhindi
- Division of Cardiology, University of British Columbia, Vancouver, B.C, Canada
| | - Meijiao Guan
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, B.C, Canada
| | - Yinshan Zhao
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, B.C, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, B.C, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, B.C, Canada
| | - G B John Mancini
- Division of Cardiology, University of British Columbia, Vancouver, B.C, Canada.
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23
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Wood DA, Lauck SB, Cairns JA, Humphries KH, Cook R, Welsh R, Leipsic J, Genereux P, Moss R, Jue J, Blanke P, Cheung A, Ye J, Dvir D, Umedaly H, Klein R, Rondi K, Poulter R, Stub D, Barbanti M, Fahmy P, Htun N, Murdoch D, Prakash R, Barker M, Nickel K, Thakkar J, Sathananthan J, Tyrell B, Al-Qoofi F, Velianou JL, Natarajan MK, Wijeysundera HC, Radhakrishnan S, Horlick E, Osten M, Buller C, Peterson M, Asgar A, Palisaitis D, Masson JB, Kodali S, Nazif T, Thourani V, Babaliaros VC, Cohen DJ, Park JE, Leon MB, Webb JG. The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers. JACC Cardiovasc Interv 2019; 12:459-469. [DOI: 10.1016/j.jcin.2018.12.020] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
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24
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Sedlak TL, Guan M, Lee M, Humphries KH, Johnson BD, Pepine CJ, Merz CNB. Ischemic Predictors of Outcomes in Women With Signs and Symptoms of Ischemia and Nonobstructive Coronary Artery Disease. JAMA Cardiol 2018; 1:491-2. [PMID: 27438329 DOI: 10.1001/jamacardio.2016.0740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tara L Sedlak
- Vancouver General Hospital, Vancouver, British Columbia, Canada2Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meijiao Guan
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - May Lee
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Karin H Humphries
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada3British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - B Delia Johnson
- Department of Cardiovascular Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carl J Pepine
- Department of Epidemiology, University of Florida, Gainesville
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California
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25
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Humphries KH, Gao M, Lee MK, Izadnegahdar M, Holmes DT, Scheuermeyer FX, Mackay M, Mattman A, Grafstein E. Sex Differences in Cardiac Troponin Testing in Patients Presenting to the Emergency Department with Chest Pain. J Womens Health (Larchmt) 2018; 27:1327-1334. [PMID: 30010472 DOI: 10.1089/jwh.2017.6812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Elevated cardiac troponin (cTn), with signs/symptoms of ischemia, is a key element in a diagnosis of myocardial infarction (MI). Underdiagnosis of MI in women has been attributed to atypical symptoms, inconsistent ECG findings, and less diagnostic testing. We sought to determine if there are sex differences in cTn testing following presentation to the emergency department (ED) with a chief complaint of ischemic chest pain (CP) and if presentation affects diagnostic assessment. METHODS All adults presenting to six hospital EDs in the Vancouver, Canada with a chief complaint of ischemic CP from 2009 to 2013 were included. The highest cTn level within 24 hours of ED presentation was used. CP was classified into cardiac- or respiratory dominant based on standard Canadian Emergency Department Triage and Acuity Scale coding. Chi-square testing was used to test for sex differences in CP categories and cTn testing within 24 hours. Logistic regression models were used to examine the association between sex, cTn testing, and CP categories. RESULTS Of 27,063 patients with ischemic CP, cardiac presentation was more common in men than women, irrespective of age. Among cardiac CP, 24.7% of men were <50 years compared to 18.2% of women; however, more women (19.9%) than men (11.6%) were >80 years. Overall, women were 1.8% less likely to have cTn testing; in patients <50 years, testing was markedly lower in women compared to men [odds ratio, OR (95% confidence intervals, CI) 0.78 (0.70-0.87)]. The odds of cardiac catheterization within 90 days of ED presentation were lower in women [OR, (95% CI) 0.52 (0.44-0.63)]. Even with cardiac CP, 17.7% of women versus 32.7% of men had cardiac catheterization. CONCLUSIONS In men and women presenting to the ED with ischemic CP, cTn testing overall is similar except among young women under 50 years old, where it is markedly lower. Women undergo less cardiac catheterization, irrespective of CP type.
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Affiliation(s)
- Karin H Humphries
- 1 Division of Cardiology, University of British Columbia , Vancouver, British Columbia, Canada .,2 BC Centre for Improved Cardiovascular Health Vancouver, British Columbia, Canada
| | - Min Gao
- 2 BC Centre for Improved Cardiovascular Health Vancouver, British Columbia, Canada
| | - May K Lee
- 2 BC Centre for Improved Cardiovascular Health Vancouver, British Columbia, Canada
| | - Mona Izadnegahdar
- 2 BC Centre for Improved Cardiovascular Health Vancouver, British Columbia, Canada
| | - Daniel T Holmes
- 3 Department of Pathology and Lab Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Frank X Scheuermeyer
- 4 Department of Emergency Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Martha Mackay
- 5 School of Nursing, University of British Columbia , Vancouver, British Columbia, Canada
| | - Andre Mattman
- 3 Department of Pathology and Lab Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Eric Grafstein
- 4 Department of Emergency Medicine, University of British Columbia , Vancouver, British Columbia, Canada
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26
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Brunham LR, Lynch K, English A, Sutherland R, Weng J, Cho R, Wong GC, Anis AH, Francis GA, Khan NA, McManus B, Wood D, Walley KR, Leipsic J, Humphries KH, Hoens A, Krahn AD, John Mancini GB, Pimstone S. The design and rationale of SAVE BC: The Study to Avoid CardioVascular Events in British Columbia. Clin Cardiol 2018; 41:888-895. [PMID: 29635745 DOI: 10.1002/clc.22959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/20/2018] [Accepted: 03/30/2018] [Indexed: 11/05/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is highly heritable, particularly when it occurs at a young age. The screening of individuals with premature ASCVD, although often recommended, is not routinely performed. Strategies to address this gap in care are essential. We designed the Study to Avoid CardioVascular Events in British Columbia (SAVE BC) as a prospective, observational study of individuals with a new diagnosis of very premature ASCVD (defined as age ≤ 50 years in males and age ≤ 55 years in females) and their first-degree relatives (FDRs) and spouses. FDRs and spouses will undergo screening for cardiovascular (CV) risk factors and subclinical ASCVD using a structured screening algorithm. All subjects will be followed longitudinally for ≥10 years. The overall goal of SAVE BC is to evaluate the yield of a structured screening program for identifying individuals at risk of premature ASCVD. The primary objectives of SAVE BC are to identify and follow index cases with very premature ASCVD and their FDRs and to determine the diagnostic yield of a structured screening program for these individuals. We will collect data on CV risk factors, medication use, CV events, and healthcare costs in these individuals. SAVE BC will provide insight regarding approaches to identify individuals at risk for premature ASCVD with implications for prevention and treatment in this population.
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Affiliation(s)
- Liam R Brunham
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Kelsey Lynch
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Amy English
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Rory Sutherland
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Jian Weng
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Raymond Cho
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Graham C Wong
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Aslam H Anis
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, Canada
| | - Gordon A Francis
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, Canada
| | - Bruce McManus
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada.,Prevention of Organ Failure (PROOF) Centre of Excellence, Vancouver, Canada
| | - David Wood
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Keith R Walley
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Karin H Humphries
- Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, Canada.,BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - Alison Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Andrew D Krahn
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - G B John Mancini
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Simon Pimstone
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
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27
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Khan NA, Rabkin SW, Zhao Y, McAlister FA, Park JE, Guan M, Chan S, Humphries KH. Effect of Lowering Diastolic Pressure in Patients With and Without Cardiovascular Disease. Hypertension 2018; 71:840-847. [DOI: 10.1161/hypertensionaha.117.10177] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 08/29/2017] [Accepted: 02/05/2018] [Indexed: 12/26/2022]
Abstract
Systolic and diastolic blood pressure thresholds, below which cardiovascular events increase, are widely debated. Using data from the SPRINT (Systolic Blood Pressure Intervention Trial), we evaluated the relation between systolic and diastolic pressure and cardiovascular events among 1519 participants with or 7574 without prior cardiovascular disease. Using Cox regression, we examined the composite risk of myocardial infarction, other acute coronary syndrome, stroke, heart failure, or cardiovascular death, and follow-up systolic and diastolic pressure were analyzed as time-dependent covariates for a median of 3.1 years. Models were adjusted for age, sex, baseline systolic pressure, body mass index, 10-year Framingham risk score, and estimated glomerular filtration rate. A J-shaped relationship with diastolic pressure was observed in both treatment arms in patients with or without cardiovascular disease (
P
nonlinearity≤0.002). When diastolic pressure fell <55 mm Hg, the hazards were at least 25% higher relative to 70 mm Hg (
P
=0.29). The hazard ratios (95% CI) of diastolic pressure <55 mm Hg versus 55 to 90 mm Hg were 1.68 (1.16–2.43),
P
value 0.006 and 1.52 (0.99–2.34),
P
value 0.06 in patients without and with prior cardiovascular disease, respectively. After adjusting for follow-up diastolic pressure, follow-up systolic pressure was not associated with the outcome in those without prior cardiovascular disease (
P
=0.64). In those with cardiovascular disease, adjusting for diastolic pressure, follow-up systolic pressure was associated with the risk in the intensive arm (hazard ratio per 10 mm Hg decrease, 0.86; 95% CI, 0.75–0.99;
P
interaction=0.02). Although the observed J-shaped relationship may be because of reverse causality in the SPRINT population, we advise caution in aggressively lowering diastolic pressure.
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Affiliation(s)
- Nadia A. Khan
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Simon W. Rabkin
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Yinshan Zhao
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Finlay A. McAlister
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Julie E. Park
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Meijiao Guan
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Sammy Chan
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Karin H. Humphries
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
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28
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Radico F, Zimarino M, Fulgenzi F, Ricci F, Di Nicola M, Jespersen L, Chang SM, Humphries KH, Marzilli M, De Caterina R. Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: a systematic review and meta-analysis. Eur Heart J 2018; 39:2135-2146. [DOI: 10.1093/eurheartj/ehy185] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 03/20/2018] [Indexed: 02/07/2023] Open
Affiliation(s)
- Francesco Radico
- Institute of Cardiology and Center of Excellence on Aging, “G. d’Annunzio” University, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy
- Department of Neurosciences, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, University G. d’Annunzio, Via Luigi Polacchi, 66100, Chieti, Italy
| | - Marco Zimarino
- Institute of Cardiology and Center of Excellence on Aging, “G. d’Annunzio” University, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy
| | - Fabio Fulgenzi
- Institute of Cardiology and Center of Excellence on Aging, “G. d’Annunzio” University, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy
| | - Fabrizio Ricci
- Department of Neurosciences, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, University G. d’Annunzio, Via Luigi Polacchi, 66100, Chieti, Italy
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University “G. d'Annunzio” Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy
| | - Lasse Jespersen
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
| | - Su Min Chang
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, 6565 Fannin Street, Houston, TX 77030, USA
| | - Karin H Humphries
- Division of Cardiology, Department of Medicine, BC Centre for Improved Cardiovascular Health, St Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
| | - Mario Marzilli
- Department of Cardiology, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - Raffaele De Caterina
- Institute of Cardiology and Center of Excellence on Aging, “G. d’Annunzio” University, C/o Ospedale SS. Annunziata, Via dei Vestini, 66013 Chieti, Italy
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29
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Mohammadifard N, Gotay C, Humphries KH, Ignaszewski A, Esmaillzadeh A, Sarrafzadegan N. Electrolyte minerals intake and cardiovascular health. Crit Rev Food Sci Nutr 2018. [DOI: 10.1080/10408398.2018.1453474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Noushin Mohammadifard
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Carolyn Gotay
- Centre of Excellence in Cancer Prevention, Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Karin H. Humphries
- Division of Cardiology, The University of British Columbia, Vancouver, Canada
| | - Andrew Ignaszewski
- Division of Cardiology, The University of British Columbia, Vancouver, Canada
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Canada
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Humphries KH, Lee MK, Izadnegahdar M, Gao M, Holmes DT, Scheuermeyer FX, Mackay M, Mattman A, Grafstein E. Sex Differences in Diagnoses, Treatment, and Outcomes for Emergency Department Patients With Chest Pain and Elevated Cardiac Troponin. Acad Emerg Med 2018; 25:413-424. [PMID: 29274187 DOI: 10.1111/acem.13371] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE While sex differences in the treatment and outcomes of subjects with acute coronary syndromes are well documented, little is known about the impact of cardiac troponin (cTn) levels obtained in the emergency department (ED) on the observed sex differences. We sought to determine whether cTn levels by chest pain features modify sex differences in diagnosis, treatment, and outcomes in patients presenting with chest pain suggestive of ischemia. METHODS All adults presenting to two hospitals in Vancouver, Canada, between May 2008 and March 2013 with ischemic chest pain and with cTn testing were included in the study. Outcomes were obtained through data linkage with population-based administrative data sets, including Vital Statistics (death), Discharge Abstract Database (hospitalizations), and PharmaNet (medications). Cumulative event rates for the composite major adverse cardiac event (MACE) endpoint (death, myocardial infarction [MI], incident admission for heart failure or for angina requiring diagnostic catheterization or revascularization) were estimated for each sex and cTn level using the Kaplan-Meier method; Cox models were used to estimate hazard ratios and 95% confidence interval (CIs) for 1-year MACE and 7-day catheterization. Logistic models were used to estimate odds ratios (ORs) and 95% CI for 90-day medication use. RESULTS Over the 5-year study period, 25,539 patients presented to the ED with chest pain of which 7,272 (2,933 females and 4,339 males) met the inclusion criteria. Among patients with chest pain with cardiac features/history and cTn > 99th percentile, females were less likely to be diagnosed with MI (46.4% vs. 57.5%). Females in the cTnI > 99th percentile group had the worst outcomes with a 1-year MACE rate of 22.7% (95% CI = 18.5-27.7) versus 18.8% (95% CI = 16.2-21.6), although this difference was attenuated and not statistically significant after adjustment for baseline differences. Overall, females underwent fewer diagnostic catheterizations than males within 7 days of admission to the ED. Even when cTn was above the 99th percentile and the chest pain was cardiac in nature, 48.4% of females underwent a diagnostic catheterization compared to 64.3% of males (p < 0.001). Within 90 days of discharge, females were less likely to use the evidence-based cardiac medications. The most striking sex differences were noted when cTnI levels were > 99th percentile and when the chest pain was cardiac in nature; males filled 25% more prescriptions for statins than their female counterparts. Adjustment for baseline differences did not attenuate this difference. CONCLUSIONS Sex differences in diagnosis and treatment after presentation to the ED with chest pain are not explained by differences in chest pain features or levels of cTn. Even when females have cardiac chest pain and cTn levels > 99th percentile, they are less likely to be diagnosed with MI, less likely to undergo diagnostic cardiac catheterization within 7 days, and less likely to use evidence-based cardiac medications, but they have the highest 1-year MACE rate. The higher MACE rate appears to be driven by the higher burden of comorbid conditions.
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Affiliation(s)
- Karin H. Humphries
- Division of Cardiology; University of British Columbia; Vancouver BC Canada
- BC Centre for Improved Cardiovascular Health; Vancouver BC Canada
- Centre for Health Evaluation and Outcomes Sciences; Vancouver BC Canada
| | - May K. Lee
- Division of Cardiology; University of British Columbia; Vancouver BC Canada
- BC Centre for Improved Cardiovascular Health; Vancouver BC Canada
| | - Mona Izadnegahdar
- Division of Cardiology; University of British Columbia; Vancouver BC Canada
- BC Centre for Improved Cardiovascular Health; Vancouver BC Canada
| | - Min Gao
- BC Centre for Improved Cardiovascular Health; Vancouver BC Canada
| | - Daniel T. Holmes
- Division of Endocrinology; University of British Columbia; Vancouver BC Canada
| | - Frank X. Scheuermeyer
- Department of Emergency Medicine; University of British Columbia; Vancouver BC Canada
| | - Martha Mackay
- School of Nursing; University of British Columbia; Vancouver BC Canada
- BC Centre for Improved Cardiovascular Health; Vancouver BC Canada
- Centre for Health Evaluation and Outcomes Sciences; Vancouver BC Canada
| | - Andre Mattman
- Department of Pathology and Lab Medicine; University of British Columbia; Vancouver BC Canada
| | - Eric Grafstein
- Department of Emergency Medicine; University of British Columbia; Vancouver BC Canada
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Humphries KH, Pilote L. Research in Women's Cardiovascular Health-Progress at Last? Can J Cardiol 2017; 34:349-353. [PMID: 29290365 DOI: 10.1016/j.cjca.2017.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Karin H Humphries
- BC Center for Improved Cardiovascular Health, Vancouver, British Columbia, Canada.
| | - Louise Pilote
- Divisions of General Internal Medicine and Clinical Epidemiology, Department of Medicine, Research Institute, McGill University Health Center, Montréal, Québec, Canada
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Mohammadifard N, Humphries KH, Gotay C, Mena-Sánchez G, Salas-Salvadó J, Esmaillzadeh A, Ignaszewski A, Sarrafzadegan N. Trace minerals intake: Risks and benefits for cardiovascular health. Crit Rev Food Sci Nutr 2017; 59:1334-1346. [PMID: 29236516 DOI: 10.1080/10408398.2017.1406332] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Minerals play a major role in regulating cardiovascular function. Imbalances in electrolyte minerals are frequent and potentially hazardous occurrences that may lead to the development of cardiovascular diseases (CVDs). Transition metals, such as iron, zinc, copper and selenium, play a major role in cell metabolism. However, there is controversy over the effects of dietary and supplemental intake of these metals on cardiovascular risk factors and events. Since their pro-oxidant or antioxidant functions can have different effects on cardiovascular health. While deficiency of these trace elements can cause cardiovascular dysfunction, several studies have also shown a positive association between metal serum levels and cardiovascular risk factors and events. Thus, a J- or U-shaped relationship between the transition minerals and cardiovascular events has been proposed. Given the existing controversies, large, well-designed, long-term, randomized clinical trials are required to better examine the effects of trace mineral intake on cardiovascular events and all-cause mortality in the general population. In this review, we discuss the role of dietary and/or supplemental iron, copper, zinc, and selenium on cardiovascular health. We will also clarify their clinical applications, benefits, and harms in CVDs prevention.
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Affiliation(s)
- Noushin Mohammadifard
- a Hypertension Research Center , Cardiovascular Research Institute, Isfahan University of Medical Sciences , Isfahan , Iran.,b Interventional Cardiology Research Center , Cardiovascular Research Institute, Isfahan University of Medical Sciences , Isfahan , Iran
| | - Karin H Humphries
- c Women's Cardiovascular Health , Department of Medicine, The University of British Columbia , Vancouver , Canada
| | - Carolyn Gotay
- d Centre of Excellence in Cancer Prevention, Faculty of Medicine, School of Population and Public Health, The University of British Columbia , Vancouver , Canada
| | - Guillermo Mena-Sánchez
- e Human Nutrition Unit , Department of Biochemistry & Biotechnology , IISPV, School of Medicine, Rovira i Virgili University, and CIBER Obesity and Nutrition , Reus , Spain
| | - Jordi Salas-Salvadó
- e Human Nutrition Unit , Department of Biochemistry & Biotechnology , IISPV, School of Medicine, Rovira i Virgili University, and CIBER Obesity and Nutrition , Reus , Spain
| | - Ahmad Esmaillzadeh
- f Obesity and Eating Habits Research Center , Endocrinology and Metabolism Molecular, Cellular Sciences Institute, Tehran University of Medical Sciences , Tehran , Iran.,g Department of Community Nutrition , School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences , Tehran , Iran.,h Department of Community Nutrition , School of Nutrition and Food Science, Isfahan University of Medical Sciences , Isfahan , Iran
| | - Andrew Ignaszewski
- i Division of Cardiology, Faculty of Medicine, The University of British Columbia , Vancouver , Canada
| | - Nizal Sarrafzadegan
- j Isfahan Cardiovascular Research Center , Cardiovascular Research Institute, Isfahan University of Medical Sciences , Isfahan , Iran
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Ramanathan K, Abel JG, Park JE, Fung A, Mathew V, Taylor CM, Mancini GJ, Gao M, Ding L, Verma S, Humphries KH, Farkouh ME. Surgical Versus Percutaneous Coronary Revascularization in Patients With Diabetes and Acute Coronary Syndromes. J Am Coll Cardiol 2017; 70:2995-3006. [DOI: 10.1016/j.jacc.2017.10.029] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 09/29/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
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Tu AW, Humphries KH, Lear SA. Longitudinal changes in visceral and subcutaneous adipose tissue and metabolic syndrome: Results from the Multicultural Community Health Assessment Trial (M-CHAT). Diabetes Metab Syndr 2017; 11 Suppl 2:S957-S961. [PMID: 28711515 DOI: 10.1016/j.dsx.2017.07.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/06/2017] [Indexed: 12/21/2022]
Abstract
AIM Few studies have examined whether longitudinal changes in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), independent of each other, are associated with the risk of developing metabolic syndrome (MetS). The objective of this study was to examine the longitudinal effects of VAT and SAT on MetS and metabolic risk factors in a multi-ethnic sample of Canadians followed for 5-years. MATERIALS AND METHODS In total, 598 adults of the Multicultural Community Health Assessment Trial (M-CHAT) were included in this study. Assessments of body composition using computed tomography (CT) and metabolic risk factors were conducted at baseline, 3-, and 5-years. Mixed-effects logistic regression was used to model the longitudinal effects of VAT and SAT on MetS and metabolic risk factors. RESULTS There were significant between-person (cross-sectional) effects such that for every 10cm2 higher VAT, the odds of MetS, high-risk fasting glucose levels and high-risk HDL-C levels significantly increased by 16% (95% CI: 9-24%), 11% (3-20%), and 7% (0-14%) respectively. Significant within-person (longitudinal) effects were also found such that for every 10cm2 increase in VAT the odds of MetS and high-risk triglyceride levels significantly increased by 23% (9-39%) and 30% (14-48%), respectively. Cross-sectional or longitudinal changes in SAT were not associated with MetS or metabolic risk factors. CONCLUSIONS This study found a direct relationship between longitudinal change in VAT and MetS risk independent of changes in SAT. Clinical practice should focus on the reduction of VAT to improve cardiovascular health outcomes.
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Affiliation(s)
- Andrew W Tu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Adatia F, Galway S, Grubisic M, Lee M, Daniele P, Humphries KH, Sedlak TL. Cardiac Medication Use in Patients with Acute Myocardial Infarction and Nonobstructive Coronary Artery Disease. J Womens Health (Larchmt) 2017; 26:1185-1192. [DOI: 10.1089/jwh.2016.5984] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Shannon Galway
- Vancouver General Hospital, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Maja Grubisic
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - May Lee
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - Patrick Daniele
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - Karin H. Humphries
- University of British Columbia, Vancouver, Canada
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - Tara L. Sedlak
- Vancouver General Hospital, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
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Deyell MW, Ferguson AA, Palmer L, Humphries KH, Klein GJ, Krahn AD. In Memoriam: Dr Charles R. Kerr. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Galway S, Adatia F, Grubisic M, Lee M, Daniele P, Humphries KH, Sedlak TL. Sex Differences in Cardiac Medication Use Post-Catheterization in Patients Undergoing Coronary Angiography for Stable Angina with Nonobstructive Coronary Artery Disease. J Womens Health (Larchmt) 2017; 26:976-983. [DOI: 10.1089/jwh.2016.5983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shannon Galway
- Department of Medicine, Vancouver General Hospital, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Falisha Adatia
- Department of Medicine, Vancouver General Hospital, Vancouver, Canada
| | - Maja Grubisic
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - May Lee
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - Patrick Daniele
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - Karin H. Humphries
- University of British Columbia, Vancouver, Canada
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - Tara L. Sedlak
- Department of Medicine, Vancouver General Hospital, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
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Humphries KH, Mancini GJ. Reduction of LDL-C-related residual cardiovascular risk with ezetimibe: are mechanistic considerations warranted in practice? Eur Heart J 2017; 38:2276-2278. [DOI: 10.1093/eurheartj/ehx275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Humphries KH, Izadnegahdar M, Sedlak T, Saw J, Johnston N, Schenck-Gustafsson K, Shah RU, Regitz-Zagrosek V, Grewal J, Vaccarino V, Wei J, Bairey Merz CN. Sex differences in cardiovascular disease - Impact on care and outcomes. Front Neuroendocrinol 2017; 46:46-70. [PMID: 28428055 PMCID: PMC5506856 DOI: 10.1016/j.yfrne.2017.04.001] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/31/2017] [Accepted: 04/13/2017] [Indexed: 02/07/2023]
Affiliation(s)
- K H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, Canada; BC Centre for Improved Cardiovascular Health, Vancouver, Canada.
| | - M Izadnegahdar
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - T Sedlak
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - J Saw
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - N Johnston
- Department of Medical Sciences, Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - K Schenck-Gustafsson
- Department of Medicine, Cardiac Unit and Centre for Gender Medicine, Karolinska University Hospital and Karolinska Institutet, Sweden
| | - R U Shah
- Division of Cardiovascular Medicine, University of Utah School of Medicine, USA
| | - V Regitz-Zagrosek
- Institute of Gender in Medicine (GIM) and Center for Cardiovascular Research (CCR) Charité, University Medicine Berlin and DZHK, Partner Site Berlin, Germany
| | - J Grewal
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - V Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - J Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - C N Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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Abstract
Spontaneous coronary artery dissection (SCAD) is gaining recognition as an important cause of myocardial infarction, especially in young women. There has been a surge in the diagnosis of SCAD in recent years, presumably due to an increased use of coronary angiography, and the clinical availability and application of high-resolution intracoronary imaging. The improved recognition and diagnosis, together with increased publications and attention through social media, have considerably raised awareness of this condition, which was once believed to be very rare. Recent publications of moderate to large contemporary case series have helped elucidate the early natural history, presenting characteristics (clinical and angiographic), underlying etiology, management, and cardiovascular outcomes with this condition, thus providing observations and important clinical insights of value to clinicians managing this challenging and perplexing patient cohort. The aim of our review is to provide a comprehensive contemporary update of SCAD to aid health care professionals in managing these patients in both the acute and chronic settings.
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Affiliation(s)
- Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
| | - G B John Mancini
- Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Karin H Humphries
- BC Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
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Mackay MH, Singh R, Boone RH, Park JE, Humphries KH. Outcomes following percutaneous coronary revascularization among South Asian and Chinese Canadians. BMC Cardiovasc Disord 2017; 17:101. [PMID: 28420368 PMCID: PMC5395833 DOI: 10.1186/s12872-017-0535-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/12/2017] [Indexed: 01/09/2023] Open
Abstract
Background Previous data suggest significant ethnic differences in outcomes following percutaneous coronary revascularization (PCI), though previous studies have focused on subgroups of PCI patients or used administrative data only. We sought to compare outcomes in a population-based cohort of men and women of South Asian (SA), Chinese and “Other” ethnicity. Methods Using a population-based registry, we identified 41,792 patients who underwent first revascularization via PCI in British Columbia, Canada, between 2001 and 2010. We defined three ethnic groups (SA, 3904 [9.3%]; Chinese, 1345 [3.2%]; and all “Others” 36,543 [87.4%]). Differences in mortality, repeat revascularization (RRV) and target vessel revascularization (TVR), at 30 days and from 31 days to 2 years were examined. Results Adjusted mortality from 31 days to 2 years was lower in Chinese patients than in “Others” (hazard ratio [HR] 0.72; 95% confidence interval [CI] 0.53-0.97), but not different between SAs and “Others”. SA patients had higher RRV at 30 days (adjusted odds ratio [OR] 1.30; 95% CI: 1.12-1.51) and from 31 days to 2 years (adjusted hazard ratio [HR] 1.17; 95% CI: 1.06-1.30) compared to “Others”. In contrast, Chinese patients had a lower rate of RRV from 31 days to 2 years (adjusted HR 0.79; 95% CI: 0.64-0.96) versus “Others”. SA patients also had higher rates of TVR at 30 days (adjusted OR 1.35; 95% CI: 1.10-1.66) and from 31 days to 2 years (adjusted HR 1.19; 95% CI: 1.06-1.34) compared to “Others”. Chinese patients had a lower rate of TVR from 31 days to 2 years (adjusted HR 0.76; 95% CI: 0.60-0.96). Conclusions SA had higher RRV and TVR rates while Chinese Canadians had lower rates of long-term RRV, compared to those of “Other” ethnicity. Further research to elucidate the reasons for these differences could inform targeted strategies to improve outcomes.
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Affiliation(s)
- Martha H Mackay
- School of Nursing, University of British Columbia, and St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Robinder Singh
- Faculty of Medicine, University of Manitoba and St. Boniface Hospital, Winnipeg, Canada
| | - Robert H Boone
- Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, Canada
| | - Julie E Park
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, Canada
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Jackevicius CA, Tsadok MA, Essebag V, Atzema C, Eisenberg MJ, Tu JV, Lu L, Rahme E, Ho PM, Turakhia M, Humphries KH, Behlouli H, Zhou L, Pilote L. Early non-persistence with dabigatran and rivaroxaban in patients with atrial fibrillation. Heart 2017; 103:1331-1338. [DOI: 10.1136/heartjnl-2016-310672] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 11/04/2022] Open
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Fowokan AO, Lesser IA, Humphries KH, Mancini JGB, Lear SA. The predictive relationship between baseline insulin and glucose with subclinical carotid atherosclerosis after 5 years in a multi-ethnic cohort. Atherosclerosis 2017; 257:146-151. [PMID: 28135624 DOI: 10.1016/j.atherosclerosis.2016.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/09/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS We aimed at exploring the relationship between baseline insulin and glucose and the progression of carotid atherosclerosis in a multi-ethnic cohort. METHODS Males and females (n = 797) of European, Chinese, South Asian and Aboriginal origin were assessed as part of the Multicultural Community Health Assessment Trial (MCHAT) study for socio-demographics, smoking status, fasting insulin and glucose at baseline. IMT, plaque area and total area were assessed after 5 years. RESULTS A total of 545 participants returned after 5 years for a follow-up assessment. Average age of the study participants was 47.5 (SD 8.9) years. At baseline, the median and interquartile range for insulin was 62.0 (49.5) pmol/L, and glucose was 5.2 (0.60) mmol/L. Baseline glucose and insulin predicted the 5-year progression of atherosclerosis in our models, after adjusting for covariates. We found significant insulin-ethnicity interactions in the IMT model (p = 0.044) with the slope of the relationship showing that for every percentage change in insulin the Europeans experienced 7.3% more increase in IMT at 5 years than the Aboriginals. In the plaque area and total area models, there were significant glucose-ethnicity interactions (p = 0.009 and p=0.016 respectively), with the slope showing a 101% and 121% increase for plaque area and total area, respectively, in Europeans, at 5 years per percent change in glucose at baseline. Logistic regression found a significant glucose-ethnicity interaction with the presence of plaques (OR = 0.31, p = 0.03) such that compared to the Europeans, the South Asians had a lower odds of developing plaque presence. Similarly, we found glucose-ethnicity interactions in the logistic regression when comparing the Chinese to the Europeans (OR = 0.2, p=0.005), with the Chinese being less likely to develop plaque presence. CONCLUSIONS Ethnicity modifies the predictive relationship between insulin and glucose with sub-clinical indicators of carotid atherosclerosis but not consistently so.
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Affiliation(s)
- Adeleke O Fowokan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, V6B 5K3 Vancouver, BC, Canada
| | - Iris A Lesser
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, V6B 5K3 Vancouver, BC, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - John G B Mancini
- UBC Division of Cardiology, Department of Medicine, University of British Columbia, V5Z 1M9 Vancouver, BC, Canada
| | - Scott A Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, V6B 5K3 Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, V5A 1S6 Burnaby, BC, Canada; Division of Cardiology, Providence Health Care, V6Z 1Y6 Vancouver, BC, Canada.
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Sedlak TL, Humphries KH. Cardiac Rehabilitation Adherence: Another Gender-Treatment Paradox. Can J Cardiol 2016; 32:1283-1285. [DOI: 10.1016/j.cjca.2015.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 11/30/2022] Open
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Al-Mohaissen MA, Carere RG, Mancini GBJ, Humphries KH, Whalen BA, Lee T, Scheuermeyer FX, Ignaszewski AP. A Plaque Disruption Index Identifies Patients with Non-STE-Type 1 Myocardial Infarction within 24 Hours of Troponin Positivity. PLoS One 2016; 11:e0164315. [PMID: 27711184 PMCID: PMC5053518 DOI: 10.1371/journal.pone.0164315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/22/2016] [Indexed: 12/11/2022] Open
Abstract
Background Markers of plaque destabilization and disruption may have a role in identifying non-STE- type 1 Myocardial Infarction in patients presenting with troponin elevation. We hypothesized that a plaque disruption index (PDI) derived from multiple biomarkers and measured within 24 hours from the first detectable troponin in patients with acute non-STE- type 1 MI (NSTEMI-A) will confirm the diagnosis and identify these patients with higher specificity when compared to individual markers and coronary angiography. Methods We examined 4 biomarkers of plaque destabilization and disruption: myeloperoxidase (MPO), high-sensitivity interleukin-6, myeloid-related protein 8/14 (MRP8/14) and pregnancy-associated plasma protein-A (PAPP-A) in 83 consecutive patients in 4 groups: stable non-obstructive coronary artery disease (CAD), stable obstructive CAD, NSTEMI-A (enrolled within 24 hours of troponin positivity), and NSTEMI-L (Late presentation NSTEMI, enrolled beyond the 24 hour limit). The PDI was calculated and the patients’ coronary angiograms were reviewed for evidence of plaque disruption. The diagnostic performance of the PDI and angiography were compared. Results Compared to other biomarkers, MPO had the highest specificity (83%) for NSTEMI-A diagnosis (P<0.05). The PDI computed from PAPP-A, MRP8/14 and MPO was higher in NSTEMI-A patients compared to the other three groups (p<0.001) and had the highest diagnostic specificity (87%) with 79% sensitivity and 86% accuracy, which were higher compared to those obtained with MPO, but did not reach statistical significance (P>0.05 for all comparisons). The PDI had higher specificity and accuracy for NSTEMI-A diagnosis compared to coronary angiography (P<0.05). Conclusions A PDI measured within 24 hour of troponin positivity has potential to identify subjects with acute Non-ST-elevation type 1 MI. Additional evidence using other marker combinations and investigation in a sufficiently large non-selected cohort is warranted to establish the diagnostic accuracy of the PDI and its potential role in differentiating type 1 and type 2 MI in patients presenting with troponin elevation of uncertain etiology.
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Affiliation(s)
- Maha A. Al-Mohaissen
- Department of Clinical Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
- * E-mail:
| | - Ronald G. Carere
- Department of Medicine, Division of Cardiology, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - G. B. John Mancini
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karin H. Humphries
- Department of Medicine, Division of Cardiology, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Beth A. Whalen
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Frank X. Scheuermeyer
- Department of Emergency Medicine, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
| | - Andrew P. Ignaszewski
- Department of Medicine, Division of Cardiology, St. Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada
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Pelletier R, Khan NA, Cox J, Daskalopoulou SS, Eisenberg MJ, Bacon SL, Lavoie KL, Daskupta K, Rabi D, Humphries KH, Norris CM, Thanassoulis G, Behlouli H, Pilote L. Sex Versus Gender-Related Characteristics: Which Predicts Outcome After Acute Coronary Syndrome in the Young? J Am Coll Cardiol 2016; 67:127-135. [PMID: 26791057 DOI: 10.1016/j.jacc.2015.10.067] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/20/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND "Gender" reflects social norms for women and men, whereas "sex" defines biological characteristics. Gender-related characteristics explain some differences in access to care for premature acute coronary syndrome (ACS); whether they are associated with cardiovascular outcomes is unknown. OBJECTIVES This study estimated associations between gender and sex with recurrent ACS and major adverse cardiac events (MACE) (e.g., ACS, cardiac mortality, revascularization) over 12 months in patients with ACS. METHODS We studied 273 women and 636 men age 18 to 55 years from GENESIS-PRAXY (GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond-Premature Acute Coronary SYndrome), a prospective observational cohort study, who were hospitalized for ACS between January 2009 and April 2013. Gender-related characteristics (e.g., social roles) were assessed using a self-administered questionnaire, and a composite measure of gender was derived. Outcomes included recurrent ACS and MACE over 12 months. RESULTS Feminine roles and personality traits were associated with higher rates of recurrent ACS and MACE compared with masculine characteristics. This difference persisted for recurrent ACS, after multivariable adjustment (hazard ratio from score 0 to 100: 4.50; 95% confidence interval: 1.05 to 19.27), and was a nonstatistically significant trend for MACE (hazard ratio: 1.54; 95% confidence interval: 0.90 to 2.66). A possible explanation is increased anxiety, the only condition that was more prevalent in patients with feminine characteristics and that rendered the association between gender and recurrent ACS nonstatistically significant (hazard ratio: 3.56; 95% confidence interval: 0.81 to 15.61). Female sex was not associated with outcomes post-ACS. CONCLUSIONS Younger adults with ACS with feminine gender are at an increased risk of recurrent ACS over 12 months, independent of female sex.
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Affiliation(s)
- Roxanne Pelletier
- Divisions of General Internal Medicine and of Clinical Epidemiology, Department of Medicine, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nadia A Khan
- Department of Medicine, Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jafna Cox
- Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Stella S Daskalopoulou
- Division of Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Divisions of Cardiology and Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Kaberi Daskupta
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - George Thanassoulis
- Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Hassan Behlouli
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Louise Pilote
- Divisions of General Internal Medicine and of Clinical Epidemiology, Department of Medicine, The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
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Conrotto F, D'Ascenzo F, Humphries KH, Webb JG, Scacciatella P, Grasso C, D'Amico M, Biondi-Zoccai G, Gaita F, Marra S. A meta-analysis of sex-related differences in outcomes after primary percutaneous intervention for ST-segment elevation myocardial infarction. J Interv Cardiol 2016; 28:132-40. [PMID: 25884896 DOI: 10.1111/joic.12195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/20/2015] [Accepted: 03/05/2015] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The increasing use of primary percutaneous coronary intervention (pPCI) has improved clinical outcome in ST-segment elevation myocardial infarction (STEMI) patients, but the impact of sex on early and mid-term outcomes remains to be defined. METHODS Medline, Cochrane Library, Biomed Central, and Google Scholar were searched for articles describing differences in baseline, periprocedural, and midterm outcomes after pPCI, by sex. The primary end point was all-cause mortality at early and mid-term follow-up. Secondary endpoints included in-hospital bleeding and stroke. RESULTS Sixteen studies were included. Women were older, had more frequent hypertension, diabetes mellitus, and hypercholesterolemia, as well as longer ischemia time and more shock at presentation. Men were more likely to have had a previous myocardial infarction. Female sex emerged as independently associated to early mortality (OR 1.1; 95%CI, 1.02-1.18) but not to mid-term mortality (OR, 1.01; 95%CI, 0.99-1.03). The pooled analysis showed a significantly higher risk of in hospital stroke (OR, 1.69; 95%CI, 1.11-2.56) and major bleeding (OR, 2.04; 95%CI, 1.51-2.77) in women. CONCLUSIONS As compared to men, women undergoing pPCI have more bleedings and strokes, and a worse early, but not mid-term mortality. These findings may allow a better risk stratification of pPCI patients.
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Affiliation(s)
- Federico Conrotto
- Department of Cardiology, Città, Della Salute e della Scienza Hospital, Turin, Italy
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Kodali S, Williams MR, Doshi D, Hahn RT, Humphries KH, Nkomo VT, Cohen DJ, Douglas PS, Mack M, Xu K, Svensson L, Thourani VH, Tuzcu EM, Weissman NJ, Leon M, Kirtane AJ. Sex-Specific Differences at Presentation and Outcomes Among Patients Undergoing Transcatheter Aortic Valve Replacement: A Cohort Study. Ann Intern Med 2016; 164:377-84. [PMID: 26903039 DOI: 10.7326/m15-0121] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Female sex is associated with poorer outcomes after surgical aortic valve replacement (SAVR). Data on sex-specific differences after transcatheter aortic valve replacement (TAVR) are conflicting. OBJECTIVE To examine sex-specific differences in patients undergoing TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) trial. DESIGN Secondary analysis of the randomized and nonrandomized portions of the PARTNER trial. (ClinicalTrials.gov: NCT00530894). SETTING 25 hospitals in the United States, Canada, and Germany. PATIENTS High-risk and inoperable patients (1220 women and 1339 men). INTERVENTION TAVR. MEASUREMENTS Demographic characteristics, cardiac and noncardiac comorbidities, mortality, stroke, rehospitalization, vascular complications, bleeding complications, and echocardiographic valve parameters. RESULTS At baseline, women had lower rates of hyperlipidemia, diabetes, smoking, and renal disease but higher Society of Thoracic Surgeons Predicted Risk of Mortality scores (11.9% vs. 11.1%; P < 0.001). After TAVR, women had more vascular complications (17.3% vs. 10.0%; difference, 7.29 percentage points [95% CI, 4.63 to 9.95 percentage points]; P < 0.001) and major bleeding (10.5% vs. 7.7%; difference, 2.8 percentage points [CI, 0.57 to 5.04 percentage points]; P = 0.012) but less frequent moderate and severe paravalvular regurgitation (6.0% vs. 14.3%; difference, -8.3 percentage points [CI, -11.7 to -5.0 percentage points]; P < 0.001). At 30 days, the unadjusted all-cause mortality rate (6.5% vs. 5.9%; difference, 0.6 percentage point [CI, -1.29 to 2.45 percentage points]; P = 0.52) and stroke incidence (3.8% vs. 3.0%; difference, 0.8 percentage point [CI, -0.62 to 2.19 percentage points]; P = 0.28) were similar. At 1 year, all-cause mortality was significantly lower in women than in men (19.0% vs. 25.9%; hazard ratio, 0.72 [CI, 0.61 to 0.85]; P < 0.001). LIMITATION Secondary analysis that included nonrandomized trial data. CONCLUSION Despite a higher incidence of vascular and bleeding complications, women having TAVR had lower mortality than men at 1 year. Thus, sex-specific risk in TAVR is the opposite of that in SAVR, for which female sex has been shown to be independently associated with an adverse prognosis. PRIMARY FUNDING SOURCE Edwards Lifesciences.
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Affiliation(s)
- Susheel Kodali
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Mathew R. Williams
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Darshan Doshi
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Rebecca T. Hahn
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Karin H. Humphries
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Vuyisile T. Nkomo
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - David J. Cohen
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Pamela S. Douglas
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Michael Mack
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Ke Xu
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Lars Svensson
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Vinod H. Thourani
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - E. Murat Tuzcu
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Neil J. Weissman
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Martin Leon
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
| | - Ajay J. Kirtane
- From Columbia University Medical Center, New York-Presbyterian Hospital, New York University Langone Medical Center, and Cardiovascular Research Foundation, New York, New York; University of British Columbia, Vancouver, British Columbia, Canada; Mayo Clinic, Rochester, Minnesota; Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Duke Clinical Research Institute, Durham, North Carolina; Baylor Healthcare System, Dallas, Texas; Cleveland Clinic Foundation, Cleveland, Ohio
- Emory University School of Medicine, Atlanta, Georgia; and MedStar Health Research Institute, Washington, DC
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Izadnegahdar M, Mackay M, Lee MK, Sedlak TL, Gao M, Bairey Merz CN, Humphries KH. Sex and Ethnic Differences in Outcomes of Acute Coronary Syndrome and Stable Angina Patients With Obstructive Coronary Artery Disease. Circ Cardiovasc Qual Outcomes 2016; 9:S26-35. [DOI: 10.1161/circoutcomes.115.002483] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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50
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Avgil Tsadok M, Jackevicius CA, Rahme E, Humphries KH, Pilote L. Sex Differences in Dabigatran Use, Safety, And Effectiveness In a Population-Based Cohort of Patients With Atrial Fibrillation. Circ Cardiovasc Qual Outcomes 2015; 8:593-9. [DOI: 10.1161/circoutcomes.114.001398] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 09/23/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Meytal Avgil Tsadok
- From the Divisions of Clinical Epidemiology (M.A.T.,E.R., L.P.) and General Internal Medicine (L.P.), McGill University Health Center, Montreal, Quebec, Canada; Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, CA (C.A.J.); Institute for Clinical Evaluative Sciences, Toronto, Canada (C.A.J.); Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada (C.A.J.); University Health
| | - Cynthia A. Jackevicius
- From the Divisions of Clinical Epidemiology (M.A.T.,E.R., L.P.) and General Internal Medicine (L.P.), McGill University Health Center, Montreal, Quebec, Canada; Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, CA (C.A.J.); Institute for Clinical Evaluative Sciences, Toronto, Canada (C.A.J.); Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada (C.A.J.); University Health
| | - Elham Rahme
- From the Divisions of Clinical Epidemiology (M.A.T.,E.R., L.P.) and General Internal Medicine (L.P.), McGill University Health Center, Montreal, Quebec, Canada; Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, CA (C.A.J.); Institute for Clinical Evaluative Sciences, Toronto, Canada (C.A.J.); Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada (C.A.J.); University Health
| | - Karin H. Humphries
- From the Divisions of Clinical Epidemiology (M.A.T.,E.R., L.P.) and General Internal Medicine (L.P.), McGill University Health Center, Montreal, Quebec, Canada; Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, CA (C.A.J.); Institute for Clinical Evaluative Sciences, Toronto, Canada (C.A.J.); Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada (C.A.J.); University Health
| | - Louise Pilote
- From the Divisions of Clinical Epidemiology (M.A.T.,E.R., L.P.) and General Internal Medicine (L.P.), McGill University Health Center, Montreal, Quebec, Canada; Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, CA (C.A.J.); Institute for Clinical Evaluative Sciences, Toronto, Canada (C.A.J.); Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada (C.A.J.); University Health
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