"Bringing on the light" in a complex clinical scenario: Optical coherence tomography-guided discontinuation of antiplatelet therapy in cancer patients with coronary artery disease (PROTECT-OCT registry)

BACKGROUND

Cancer patients with recently placed drug-eluting stents (DESs) often require premature dual antiplatelet therapy (DAPT) discontinuation for cancer-related procedures. Optical coherence tomography (OCT) can identify risk factors for stent thrombosis such as stent malapposition, incomplete strut coverage and in-stent restenosis and may help guide discontinuation of DAPT.

METHODS

We conducted a single-center prospective study in cancer patients with recently placed (1-12 months) DES who required premature DAPT discontinuation. Patients were evaluated with diagnostic coronary angiogram and OCT. Individuals with appropriate stent strut coverage, expansion, apposition, and absence of in-stent restenosis or intraluminal masses were considered low risk and transiently discontinued DAPT to allow optimal cancer therapy. Patients who did not meet all these criteria were considered high risk and underwent further endovascular treatment when appropriate and bridging with low-molecular weight heparin. The incidence of adverse cardiovascular events was assessed after the procedure and at 12 months.

RESULTS

A total of 40 patients were included. Twenty-seven patients (68%) were considered low risk by OCT criteria and DAPT was transiently discontinued. Thirteen patients (32%) were considered high risk with one or more OCT findings: uncovered stent struts (4 patients, 10%); stent underexpansion (3 patients, 8%); malapposition (8 patients, 20%); in-stent restenosis (2 patients, 5%). The high-risk patients with uncovered stent struts and malapposition underwent additional stent dilatation. There were no cardiovascular events in the low-risk group. One myocardial infarction occurred in the high-risk group. Fourteen non-cardiac deaths were registered before 12 months due to cancer progression or cancer therapy.

CONCLUSION

OCT imaging allows identification of low-risk cancer patients with DES placed who may safely discontinue DAPT and proceed with cancer-related surgery or procedures.

Prediction of developmental attainments of institutionalized mentally retarded children

Two regression equations using chronological age and either IQ or the Fisher and Zeaman K score were developed to predict Developmental Record ratings of institutionalized mentally retarded children over a 2-year interval (N = 200), a 4-year interval (N = 165), and an 8-year interval (N = 95). Although the correlations between predicted and obtained scores for both equations were quite high even over an 8-year interval, analysis of mean differences revealed that the equation using IQ yielded more accurate predictions. If future studies support the use of such equations with other subjects in other settings, they should be useful in estimating later developmental attainments of mentally retarded children.

Developmental changes of institutionalized mentally retarded children: a semilongitudinal study

Developmental Record ratings were obtained for 200 institutionalized mentally retarded children over a 3-year period. Following a principal components analysis to determine the most appropriate form of inputting data, we obtained semilongitudinal developmental curves for children at each of four levels of retardation and for boys and girls separately. Results indicated that differences in measured intelligence are associated with differences in various kinds of developmental behavior and that between the ages of 7 and 20 years the relationship is primarily a linear one. When subjects were divided according to sex instead of level of retardation, differences appeared to be minimal. These results should be helpful in predicting later attainments of institutionalized retarded children since ratings on the Developmental Record can be translated into specific types of developmental behavior.

Social and play behaviors of institutionalized mongoloid and nonmongoloid retarded children

A total of 24 institutionalized retarded children, 12 mongoloid (Down's syndrome) and 12 nonmongoloid, were observed in dyadic interaction with peers in a free-play situation, and a number of specific peer-social and non-social behaviors were recorded as they occurred. Differences between mongoloid and nonmongoloid Ss were most apparent on several social behavior categories which support the stereotypic conception of mongoloids as more sociable, gregarious, etc. Differences were most apparent for the mongoloid boys. The possible influence of tranquilizer drugs and cottage placements on the observed differences was discussed.

Predictors of parent involvement with institutionalized retarded children

A multivariate discriminant function analysis was used to explore 22 biographical and psychological variables which were thought to have some possible bearing on frequency of family visits to the institution and attendance at parent conferences. The analysis identified 6 of the variables as significant predictors, although the factors related to the 2 measures of parental involvement were not identical. The 6 major predictors of lack of involvement were: presence of physical anomalies, high disparity between CA and social maturity, greater distance from the institution, low occupational level of the father, maintenance payments not being required, and the parent having custody being divorced and remarried.

Social and play behavior of children with Down's syndrome in sexually homogeneous and heterogeneous dyads

Ss were 6 male and 6 female children with Down's syndrome (mongolism) who interacted in dyads in sexually homogeneous and heterogeneous free-play situations. Actual, observable behaviors were recorded to investigate sex differences in, and the influence of sex of peer on, social and play behavior. Girls engaged in more sedentary activities than boys and sexual homogeneity resulted in less sedentary activity than sexual heterogeneity. Peer-sex seems to influence more the type rather than the amount of social interaction with male mongoloids being more influenced by peer-sex than girls. Implications of the results for future studies of mental retardate social behavior and studies of the stereotypic conception of mongoloids as cheerful, friendly, and so forth, were discussed.