Dataset Information

Novel risk model for predicting acute adverse drug reactions following cardiac catheterization from TRUST study (The Safety and toleRability of UltraviSt in Patients Undergoing Cardiac CaTheterization).

ABSTRACT: Background:Acute drug reactions (ADRs) are common complications of contrast administration following cardiac catheterization. Serious reactions may be life threatening. However, few risk models for predicting ADRs exist. The study aims to develop a novel tool for predicting the risk of ADRs [occurring within 1 hour in patients undergoing coronary angiography or percutaneous coronary intervention (PCI)]. Methods:A total of 17,139 consecutive patients included in the TRUST study were randomly (2:1) assigned to a development data set (n=11,426) or a validation data set (n=5,713). Multivariate logistic regression was applied to identify independent predictors of contrast-induced nephropathy (CIN), including age, contrast dose, premedication, and prehydration. The performance of our model was assessed using the c-statistic for discrimination and the Hosmer-Lemeshow test for calibration. Results:The overall incidence of ADRs was 42 (0.37%) in the development data set: 0.09% in the low-risk category (score: 0-2), 0.36% in the moderate-risk category (score: 3-4), and 1.78% in the high-risk category (score ?5). The risk score across the subgroup of the study population exhibited good discrimination and predictive ability for ADRs (c-statistic: 0.694). Meanwhile, the calibration was also demonstrated to be accurate by the Hosmer-Lemeshow goodness-of-fit test (P=0.305). Conclusions:Our data showed that our simple risk model showed good discrimination and predictive ability of ADRs following cardiac catheterization.

SUBMITTER: He Y

PROVIDER: S-EPMC6531703 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Novel risk model for predicting acute adverse drug reactions following cardiac catheterization from TRUST study (The Safety and toleRability of UltraviSt in Patients Undergoing Cardiac CaTheterization).

He Yibo Y Huang Yuming Y Yang Junqing J Liu Jin J Sun Guoli G Song Feier F Chen Shiqun S Tan Ning N Ni Zhonghan Z Liu Yong Y Chen Jiyan J

Journal of thoracic disease 20190401 4

<h4>Background</h4>Acute drug reactions (ADRs) are common complications of contrast administration following cardiac catheterization. Serious reactions may be life threatening. However, few risk models for predicting ADRs exist. The study aims to develop a novel tool for predicting the risk of ADRs [occurring within 1 hour in patients undergoing coronary angiography or percutaneous coronary intervention (PCI)].<h4>Methods</h4>A total of 17,139 consecutive patients included in the TRUST study wer ...[more]

PMID: 31179105

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Project description:Objective The rate and predictors of respiratory adverse events (RAEs) during transport discharged from operating room after interventional cardiac catheterization in children remain unclear. This study aimed to investigate the incidence and predictors, and to construct a nomogram for predicting RAEs during transport in this pediatric surgical treatment. Methods This prospective cohort study enrolled 290 consecutive pediatric patients who underwent ventricular septal defects (VSD), atrial septal defects (ASD), and patent ductus arteriosus (PDA) between February 2019 and December 2020. Independent predictors were used to develop a nomogram, and a bootstrap resampling approach was used to conduct internal validation. Composite RAEs were defined as the occurrence of at least 1 complication regarding laryngospasm, bronchospasm, apnea, severe cough, airway secretions, airway obstruction, and oxygen desaturation. Results The rate of RAEs during transport was 23.1% (67 out of 290). Multivariate analysis identified age (vs. ≤3 years, adjusted odds ratio (aOR) = 0.507, 95% conﬁdence interval (CI), 0.268–0.958, P = 0.036), preoperative upper respiratory tract infections (URI, aOR = 2.335, 95% CI, 1.223–4.460, P = 0.01), type of surgery (vs. VSD, for ASD, aOR = 2.856, 95% CI, 1.272–6.411, P = 0.011; for PDA, aOR = 5.518, 95% CI, 2.425–12.553, P < 0.001), morphine equivalent (vs. ≤0.153 mg/kg, aOR = 2.904, 95% CI, 1.371–6.150, P = 0.005), atropine usage (aOR = 0.463, 95% CI, 0.244–0.879, P = 0.019), and RAEs during extubation to transport (aOR = 5.004, 95% CI, 2.633–9.511, P < 0.001) as independent predictors of RAEs during transport. These six candidate predictors were used to develop a nomogram, which showed a C-statistic value of 0.809 and good calibration (P = 0.844). Internal validation revealed similarly good discrimination (C-statistic, 0.782; 95% CI, 0.726–0.837) and calibration. Decision curve analysis (DCA) also demonstrated the clinical usefulness of the nomogram. Conclusion The high rate of RAEs during transport reminds us of the need for more medical care and attention. The proposed nomogram can reliably identify pediatric patients at high risk of RAEs during transport and guide clinicians to make proper transport plans. Our findings have important and meaningful implications for RAEs risk prediction, clinical intervention and healthcare quality control.

Project description:Plasma soluble CD40 ligand (sCD40L) is mainly generated by cleavage of CD40L from the surface of activated platelets, and therefore considered a platelet activation marker. Although the predictive value of sCD40L for ischemic events has been demonstrated in patients with acute coronary syndromes (ACS), studies on the association of sCD40L with cardiovascular outcomes in lower risk populations yielded heterogeneous results. We therefore sought to investigate factors influencing sCD40L levels, and the predictive value of sCD40L for long-term ischemic events in unselected, aspirin-treated patients undergoing cardiac catheterization. sCD40L was determined by a commercially available enzyme-linked immunosorbent assay in 682 consecutive patients undergoing cardiac catheterization. Two-year follow-up data were obtained from 562 patients. Dual antiplatelet therapy with aspirin and clopidogrel was associated with significantly lower levels of sCD40L and lower platelet surface expressions of P-selectin and activated GPIIb/IIIa compared to aspirin monotherapy (all p≤0.01). Hypertension was linked to lower plasma concentrations of sCD40L, whereas female sex, increasing high-sensitivity C-reactive protein, and hematocrit were associated with higher sCD40L concentrations (all p<0.05). sCD40L levels were similar in patients without and with the primary endpoint in the overall study population (p = 0.4). Likewise, sCD40L levels did not differ significantly between patients without and with the secondary endpoints (both p≥0.4). Similar results were obtained when only patients with angiographically-proven coronary artery disease (n = 459), stent implantation (n = 205) or ACS (n = 125) were analyzed. The adjustment for differences in patient characteristics by multivariate regression analyses did not change the results. ROC curve analyses did not reveal cut-off values for sCD40L for the prediction of the primary or secondary endpoints. In conclusion, plasma sCD40L levels are reduced by antiplatelet therapy with clopidogrel, but not associated with long-term ischemic outcomes in unselected consecutive aspirin-treated patients undergoing cardiac catheterization.

Project description:BackgroundTransradial catheterization is associated with radial artery injury and vasomotor dysfunction and represents an accessible model of acute vascular injury in humans. We characterized vascular injury and functional recovery to understand the role of circulating endothelial progenitor cells in vascular repair.Methods and resultsIn 50 patients (aged 64±10 years, 70% male) undergoing transradial cardiac catheterization, radial artery injury was assessed by optical coherence tomography and examination of explanted vascular sheaths. Flow- and nitrate-mediated dilatation of the radial artery was assessed in both arms at baseline, at 24 hours, and at 1, 4, and 12 weeks. Circulating endothelial progenitor cell populations were quantified using flow cytometry. Late endothelial outgrowth colonies were isolated and examined in vitro. Optical coherence tomography identified macroscopic injury in 12 of 50 patients (24%), but endothelial cells (1.9±1.2×104 cells) were isolated from all arterial sheaths examined. Compared with the noncatheterized radial artery, flow-mediated vasodilatation was impaired in the catheterized artery at 24 hours (9.9±4.6% versus 4.1±3.1%, P<0.0001) and recovered by 12 weeks (8.1±4.9% versus 10.1±4.9%, P=0.09). Although the number of CD133+ cells increased 24 hours after catheterization (P=0.02), the numbers of CD34+ cells and endothelial outgrowth colonies were unchanged. Migration of endothelial cells derived from endothelial outgrowth colonies correlated with arterial function before catheterization but was not related to recovery of function following injury.ConclusionsTransradial cardiac catheterization causes endothelial denudation, vascular injury, and vasomotor dysfunction that recover over 12 weeks. Recovery of vascular function does not appear to be dependent on the mobilization or function of endothelial progenitor cells.Clinical trial registrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT02147119.

Dataset Information

Novel risk model for predicting acute adverse drug reactions following cardiac catheterization from TRUST study (The Safety and toleRability of UltraviSt in Patients Undergoing Cardiac CaTheterization).

Publications

Novel risk model for predicting acute adverse drug reactions following cardiac catheterization from TRUST study (The Safety and toleRability of UltraviSt in Patients Undergoing Cardiac CaTheterization).

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