New York Methodist Hospital

About: New York Methodist Hospital is a healthcare organization based out in Brooklyn, New York, United States. It is known for research contribution in the topics: Myocardial infarction & Percutaneous coronary intervention. The organization has 948 authors who have published 936 publications receiving 29954 citations.

Simultaneous Two-Vessel Subacute Stent Thrombosis Caused by Clopidogrel Resistance from CYP2C19 Polymorphism.

Abstract: Clopidogrel resistance from CYP2C19 polymorphism has been associated with stent thrombosis in patients undergoing percutaneous coronary intervention with drug-eluting stents. We present a case of a 76-year-old male who received drug-eluting stents to the right coronary artery and left anterior descending artery for non-ST elevation myocardial infarction and was discharged on dual antiplatelet therapy with aspirin and clopidogrel. He subsequently presented with chest pain from anterior, anteroseptal, and inferior ST segment elevation myocardial infarction. An emergent coronary angiogram revealed acute stent thrombosis with 100% occlusion of RCA and LAD that was successfully treated with thrombus aspiration and angioplasty. Although he was compliant with his dual antiplatelet therapy, he developed stent thrombosis, which was confirmed as clopidogrel resistance from homozygous CYP2C19 polymorphism.

Considerations of Fractionated Stereotactic Radiotherapy in Patients with Dentures

Abstract: Stereotactic radiotherapy (SRT) using the Gill–Thomas–Cosman (GTC) repeat localizer allows for accurate and reproducible daily setup The formation of a custom dental plate presents a challenge We present the problems of utilizing this technique in patients with dentures Twenty-seven patients were referred for fractionated SRT:15 patients had natural teeth and 12 patients had dentures The comfort and accuracy of daily setup were compared in patients with and without dentures All patients with natural teeth experienced no discomfort during the treatment and no interruptions were needed The patients with dentures were categorized into four grades (I–IV), according to the need for medical intervention and necessity for treatment interruption Two were Grade IV and SRT could not be delivered; alternate treatments were used (one had SRS and one had external RT) Three patients were Grade I, where there was minimal discomfort Grade II discomfort was encountered in three patients helped by gingival anesthetic cream with no treatment interruption and Grade III was encountered in the remaining four where the treatment was interrupted for variable periods The mean inaccuracy of daily setup was 21 ± 30 mm in patients with dentures and 048 ± 057 mm in patients with natural teeth The use of the GTC frame is well tolerated and reproducible in patients with natural teeth Variable degrees of discomfort are noted in patients with dentures and is well correlated to the degree of accuracy and reproducibility Using other fixation devices, avoiding the oral cavity may be an alternative in patients with Grade III and IV discomfort

Effect of Prior Aspirin Treatment on Patients With Acute Coronary Syndromes: Insights From the PROSPECT Study.

Abstract: BACKGROUND: Prior aspirin treatment is considered a risk factor for adverse outcomes in acute coronary syndrome (ACS) patients. The relationships between aspirin pretreatment and findings on quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS), as well as clinical outcomes, are not well understood. METHODS: In the PROSPECT trial, QCA and triple-vessel IVUS imaging were performed after successful percutaneous coronary intervention (PCI) of the culprit lesion(s) in ACS patients. We compared patients receiving aspirin within 7 days of enrollment to those naive to aspirin. Propensity score matching was performed to adjust for differences in baseline characteristics. RESULTS: Aspirin-pretreated patients (n ≤ 236; 35%) were older and more likely to have known coronary disease than those without pretreatment (P≤.01 for all). Pretreated patients had more untreated non-culprit lesions with angiographic and IVUS characteristics predictive of future events (53.1% vs 38.6%; P<.001). There were no significant differences in overall major adverse cardiac event (MACE) rates at 3 years between the aspirin and no-aspirin groups (23.6% vs 18.8%, respectively; P≤.17) in unadjusted or propensity-adjusted analyses. Prior aspirin use was not an independent predictor of MACE at 3 years (hazard ratio, 1.21; 95% confidence interval, 0.73-2.01; P≤.45). CONCLUSION: In the PROSPECT trial, aspirin pretreatment identifies an older population with more advanced coronary disease. Aspirin pretreatment was not an independent predictor of MACE in ACS patients treated with an early invasive strategy. The extent to which aspirin pretreatment is a risk factor for adverse events after PCI in ACS should be revisited.

Endoscopic ultrasound-guided fine-needle aspiration using 22- and 25-gauge needles alternately.

Abstract: guided fine−needle aspiration (FNA), the standard size of needle used is a 22−gauge needle. Larger needles have been used to obtain actual core tissue samples [1±3], but their has failed to significantly im− prove diagnostic accuracy for malignancy [2±4], except perhaps in the case of un− usual histology [5]. On the contrary, a new, smaller−caliber (25−gauge) needle has been introduced to the market by Wilson−Cook Medical Inc. (Winston− Salem, North Carolina, USA). The purpose of this study was to compare the 22− and 25−gauge needles for adequacy of tissue acquisition and diagnostic yield. The study was a retrospective review of all EUS−FNA procedures performed using 22− and 25−gauge needles alternately in the same patient. Of a total of 132 pa− tients undergoing EUS, only 16 met the inclusion criteria. The mean age was 65.1 years. The cytotechnician was present during 75% of the procedures. The needle pass was considered by the endoscopist to be difficult in 37.5% vs. 25.0% of cases using the 22− and 25−gauge needles, respectively (P = 0.7). The specimen ade− quacy rates were: cytologic 68.6 vs. 56.3 (P = 0.7), and histologic 87.5% vs. 75.0% (P = 0.6) with 22− and 25−gauge needles, respectively. Two patients were lost to follow−up. Out of the remaining 14 pa− tients, a definitive diagnosis was obtained in 85.7% (22−gauge needle) and 50.0% (25−gauge needle) (P = 0.1). When 22− and 25−gauge needles were combined, the cytologic and histologic yields, as well as the definitive diagnosis, were higher (81.3%, 93.8%, and 92.9%, respec− tively). Hence, in conclusion we found no statistically significant difference be− tween needle size despite a relatively eas− ier pass with the 25−gauge needle and higher specimen adequacy and definitive diagnosis with the 22−gauge needle. Al− though we found the two needles to com− plement each other when used alternate− ly in the same patient, the differences did not reach statistical significance due to the small number of cases. We recom− mend large prospective trials.