Author
James P. Nolan
Bio: James P. Nolan is an academic researcher from Harvard University. The author has contributed to research in topics: Myocardial infarction & Revised Cardiac Risk Index. The author has an hindex of 6, co-authored 6 publications receiving 2903 citations.
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TL;DR: If validated by prospective application, the multifactorial index may allow preoperative estimation of cardiac risk independent of direct surgical risk.
Abstract: To determine which preoperative factors might affect the development of cardiac complications after major noncardiac operations, we prospectively studied 1001 patients over 40 years of age. By multivariate discriminant analysis, we identified nine independent significant correlates of life-threatening and fatal cardiac complications: preoperative third heart sound or jugular venous distention; myocardial infarction in the preceding six months; more than five premature ventricular contractions per minute documented at any time before operation; rhythm other than sinus or presence of premature atrial contractions on preoperative electrocardiogram; age over 70 years; intraperitoneal, intrathoracic or aortic operation; emergency operation; important valvular aortic stenosis; and poor general medical condition. Patients could be separated into four classes of significantly different risk. Ten of the 19 postoperative cardiac fatalities occurred in the 18 patients at highest risk. If validated by prospective application, the multifactorial index may allow preoperative estimation of cardiac risk independent of direct surgical risk.
2,476 citations
TL;DR: Postoperative cardiac death was significantly correlated with myocardial infarction in the previous 6 months, and Notably unimportant factors included smoking, glucose intolerance, hyperlipidemia, hypertension, peripheral atherosclerotic vascular disease, angina, and distant myocardia.
327 citations
TL;DR: MULTIFACTORIAL INDEX of CARDIAC RISK in nonCARDIAC SURGICAL PROCEDURES L. L. Nussbaum, M. Murray, and T. O'Malley.
Abstract: MULTIFACTORIAL INDEX OF CARDIAC RISK IN NONCARDIAC SURGICAL PROCEDURES L. Goldman;D. Caldera;S. Nussbaum;F. Southwick;D. Krogstad;B. Murray;D. Burke;T. O'Malley;A. Goroll;C. Caplan;J. Nolan;B. Carabello;E. Slater; Survey of Anesthesiology
86 citations
TL;DR: The adrenal glands functioned differently both in men and women with cancer, and the association of hyperadrenocorticism with cancer has stimulated the curiosity of physicians for many years.
Abstract: THE association of hyperadrenocorticism with cancer has stimulated the curiosity of physicians for many years. Early work by Dobriner1 suggested that the adrenal glands functioned differently both ...
45 citations
TL;DR: For an organ exposed to bacteria from both the systemic and portal circulations, it is surprising that bacterial infections of the liver are so rare.
Abstract: For an organ exposed to bacteria from both the systemic and portal circulations, it is surprising that bacterial infections of the liver are so rare. Although viral invasion of hepatic tissue is co...
18 citations
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TL;DR: The estimated relative risk of death from an increase of one in the comorbidity score proved approximately equal to that from an additional decade of age.
5,388 citations
TL;DR: The medical profession should play a central role in evaluating evidence related to drugs, devices, and procedures for detection, management, and prevention of disease.
4,050 citations
TL;DR: The ACC and AHA have collaborated with the National Heart, Lung, and Blood Institute and stakeholder and professional organizations to develop guidelines, standards, and policies that promote optimal patient care and cardiovascular health.
Abstract: Preamble and Transition to ACC/AHA Guidelines to Reduce Cardiovascular Risk S50
The goals of the American College of Cardiology (ACC) and the American Heart Association (AHA) are to prevent cardiovascular diseases (CVD); improve the management of people who have these diseases through professional education and research; and develop guidelines, standards, and policies that promote optimal patient care and cardiovascular health. Toward these objectives, the ACC and AHA have collaborated with the National Heart, Lung, and Blood Institute (NHLBI) and stakeholder and professional organizations to develop …
3,524 citations
Emory University1, University of California, San Francisco2, University of California, San Diego3, Baylor College of Medicine4, University of Minnesota5, Virginia Commonwealth University6, Rush University Medical Center7, Texas Tech University8, Duke University9, University of Texas Health Science Center at Houston10, National Institutes of Health11
TL;DR: In this article, Anderson et al. discuss the FAHA chair election process and discuss the state of the art in the field of cancer research. But they do not discuss the role of women in this process.
3,218 citations
TL;DR: In stable patients undergoing nonurgent major noncardiac surgery, this index can identify patients at higher risk for complications and may be useful for identification of candidates for further risk stratification with noninvasive technologies or other management strategies.
Abstract: Background Cardiac complications are important causes of morbidity after noncardiac surgery. The purpose of this prospective cohort study was to develop and validate an index for risk of cardiac complications. Methods and results We studied 4315 patients aged > or = 50 years undergoing elective major noncardiac procedures in a tertiary-care teaching hospital. The main outcome measures were major cardiac complications. Major cardiac complications occurred in 56 (2%) of 2893 patients assigned to the derivation cohort. Six independent predictors of complications were identified and included in a Revised Cardiac Risk Index: high-risk type of surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, preoperative treatment with insulin, and preoperative serum creatinine >2.0 mg/dL. Rates of major cardiac complication with 0, 1, 2, or > or = 3 of these factors were 0.5%, 1.3%, 4%, and 9%, respectively, in the derivation cohort and 0.4%, 0.9%, 7%, and 11%, respectively, among 1422 patients in the validation cohort. Receiver operating characteristic curve analysis in the validation cohort indicated that the diagnostic performance of the Revised Cardiac Risk Index was superior to other published risk-prediction indexes. Conclusions In stable patients undergoing nonurgent major noncardiac surgery, this index can identify patients at higher risk for complications. This index may be useful for identification of candidates for further risk stratification with noninvasive technologies or other management strategies, as well as low-risk patients in whom additional evaluation is unlikely to be helpful.
3,183 citations