Showing papers by "Leslee J. Shaw published in 2003"

Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality.

Abstract: PURPOSE: To develop risk-adjusted multivariable models that included risk factors and coronary calcium scores determined with electron-beam computed tomography (CT) in asymptomatic patients for the prediction of all-cause mortality. MATERIALS AND METHODS: We followed up a cohort of 10,377 asymptomatic individuals undergoing cardiac risk factor evaluation and coronary calcium screening with electron-beam CT. Multivariable Cox proportional hazards models were developed to predict all-cause mortality. Risk-adjusted models incorporated traditional risk factors for coronary disease and coronary calcium scores. RESULTS: Cardiac risk factors such as family history of coronary disease (69%), hypercholesterolemia (62%), hypertension (44%), smoking (40%), and diabetes (9%) were prevalent. The frequency of coronary calcium scores was 57%, 20%, 14%, 6%, and 3% for scores of 10 or less, 11–100, 101–400, 401–1,000, and greater than 1,000, respectively. During a mean follow-up of 5.0 years ± 0.0086 (standard error of th...

Progression of coronary calcium on serial electron beam tomographic scanning is greater in patients with future myocardial infarction.

Abstract: We conducted an observational study relating the occurrence of acute myocardial infarction (MI) to coronary artery calcium progression in 817 asymptomatic subjects referred for sequential electron beam tomographic imaging (average interval 2.2 +/- 1.3 years). A calcium volume score (CVS) was used for plaque quantification. The yearly mean absolute and percent CVS changes in the 45 patients who had a MI were 147 +/- 152 and 47 +/- 50%, respectively, compared with 63 +/- 128 and 26 +/- 32%, respectively (p <0.001, p = 0.01), in patients without events.

Prognostic value of normal exercise and adenosine (99m)Tc-tetrofosmin SPECT imaging

Abstract: UNLABELLED Event rates associated with a normal or low-risk myocardial perfusion SPECT imaging study have been shown by numerous investigators to be associated with <1%/y of follow-up. Thus, the aim of this study was to evaluate the prognostic value of a normal (99m)Tc-tetrofosmin study in a geographically diverse registry of patients undergoing stress myocardial perfusion SPECT. A total of 4,728 consecutively tested patients who underwent stress (99m)Tc-tetrofosmin SPECT at 5 U.S. hospitals were included in this series. METHODS Patients were monitored for the occurrence of major cardiac events and hospitalizations. Uniform methods of data collection and standardized epidemiologic methods for follow-up were used at all centers. We used a risk-adjusted, Cox proportional hazards model to assess time to cardiac death. RESULTS Of the 4,728 patients, one third underwent adenosine stress SPECT and two thirds underwent treadmill exercise. The observed annualized survival rate for those patients with a normal (99m)Tc-tetrofosmin study was 0.6%. Similarly, excellent survival rates were noted for the male and female subsets of this population as well as for patients who could exercise and for those undergoing pharmacologic stress testing. Compared with prior published outcomes studies on stress (201)Tl or (99m)Tc-sestamibi SPECT, the overall survival rates were similar and ranged from 99.3% to 99.7%. CONCLUSION Results from this large multicenter registry provide further supportive evidence that the excellent prognosis associated with a normal SPECT scan is independent of the radiopharmaceutical used.

Prognostic value of normal exercise and adenosine (99m)Tc-tetrofosmin SPECT imaging: results from the multicenter registry of 4,728 patients.

Abstract: Event rates associated with a normal or low-risk myocardial perfusion SPECT imaging study have been shown by numerous investigators to be associated with

Symptoms, myocardial ischaemia and quality of life in women: results from the NHLBI-sponsored WISE Study.

Abstract: Aims Our goal was to evaluate health-related quality of life (QOL) in women undergoing angiography for suspected ischaemia. Methods and results QOL measurements were obtained in 406 women with chest pain symptoms in the Women’s Ischemia Syndrome Evaluation (WISE). QOL measures included a general rating (GR), Duke Activity Status Index (DASI), and the Beck Depression Inventory (BDI). Higher scores on the GR and DASI are indicative of better QOL and functioning. Higher scores on the BDI indicate more symptoms of depression. Women were stratified by the presence and absence of obstructive angiographic coronary artery disease (CAD) and by the presence and absence of myocardial ischaemia. Women with angiographic obstructive CAD had lower DASI and higher BDI scores compared to women without obstructive CAD (both P <0.05). Stratification by the presence and absence of ischaemia demonstrated that women with ischaemia had better QOL, evidenced by higher GR QOL scores and lower BDI scores (both P <0.05) than women without ischaemia. Symptoms of angina were significant independent predictors of QOL scores ( P <0.001). Conclusions Chest pain symptoms have a significant impact on health-related QOL in women undergoing coronary angiography for suspected myocardial ischaemia andare more important determinants of QOL than the underlying conditions of CAD or ischaemia.

Updated risk adjustment mortality model using the complete 1.1 dataset from the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR).

Abstract: Objectives. To revise and update a risk adjustment model for in-hospital mortality following percutaneous coronary intervention (PCI) procedures using all data from the 1.1 version of the American College of Cardiology - National Cardiovascular Data Registry (ACC-NCR). Background. A model based on data received at the ACC-NCDR from 1998-2000 was previously reported. The revision of this mortality model reflects all of the data submitted using 1. 1 data specifications and collected through the second quarter of 2001. The model was applied to selected high-risk subgroups from a sample of data collected during the year 2001 from version 2.0 of the NCDR. Methods. Data on 173,743 PCI procedures collected at the ACC-NCDR between January 1, 1998 and March 31, 2001 were analyzed. A mortality model was generated as well as separate models for presentation with and without acute myocardial infarction within 24 hours. The model was used to generate predicted mortalities that were compared to observed mortalities in more current high-risk patient subgroups in the NCDR. Results. The same factors that were previously found to be associated with increased risk of PCI mortality were re-verified in the current analysis. Inclusion of the complete 1.1 dataset produced some changes in the regression weights and the constant value. Excellent discrimination was achieved in the revised model (C-Index = 0.89). The model was applied to high-risk patient groups from data collected on 76,249 during the calendar year 2001 using the 2.0 NCDR data elements and definitions. These analyses showed a high level of agreement between observed mortality of each subgroup and the predicted mortality rates generated from the revised 1.1 PCI mortality model. Conclusions. Risk adjustment models for in-hospital mortality following PCI for all patients and for those with and without recent MI were regenerated using all data collected from the 1.1 data specifications of the ACC-NCDR and validated on high-risk groups from data collected during 2001 under data version 2.0 of the NCDR. These models reflect the most up-to-date analysis of mortality prediction from this large, multi-center national database.

Stress myocardial perfusion imaging in the diagnosis and prognosis of women with suspected coronary artery disease.

Abstract: Coronary artery disease is the single largest killer of women in the United States and claims the lives of more than 250,000 women each year. For several decades, there was the misperception that coronary artery disease was a “man’s disease.” The fact is that women are indeed vulnerable to coronary artery disease; however, they typically develop the disease 10 to 15 years later than men. Once coronary artery disease is evident, women have worse outcomes as compared with men. Therefore, early and accurate diagnosis of coronary artery disease is crucial for reducing heart disease mortality in women. Stress myocardial perfusion imaging using contemporary techniques has been shown to have significant value in the diagnosis and prognosis of coronary artery disease in women. Myocardial perfusion imaging with exercise or pharmacologic stress has been shown to add incremental value to the use of clinical variables or exercise electrocardiogram stress testing alone in the risk stratification of women with an intermediate clinical pretest likelihood of coronary artery disease. This review provides an overview of the role of stress myocardial perfusion imaging in the clinical evaluation of women with suspected coronary artery disease.