Abstract:
PURPOSE OF REVIEW:To illustrate the limitations of predictive risk models in cardiac surgery, highlight the difficulty in interpreting risk-adjusted outcome analysis and discuss the challenges of making clinical decisions based on risk predictions, particularly in high-risk patients. RECENT FINDINGS:Predictive risk models developed after logistic regression or other complex statistical analysis are commonly perceived as rigorous means to determine risk-adjusted mortality in cardiac surgery. However, the discrimination provided by those predictive models is barely better than clinical judgment. Moreover, validation studies of those models show that their calibration is inconsistent, limiting their application for comparisons between different patient cohorts. Recent data also show that, without a reasonable overlap of case-mix distributions, apparently calibrated models used for risk-adjusted outcome analysis may lead to inaccurate side-by-side comparisons of provider performance. Finally, most predictive models overestimate risk, particularly in the high-risk patients. SUMMARY:Failure to account for many biological and procedural variables and for the constantly evolving practice of surgery and perioperative medicine likely contributes to the modest predictive performance of risk models in cardiac surgery. Consequently, those models should have limited input in the analysis of provider performance and in the decision to accept or deny surgery to the high-risk patients.
journal_name
Curr Opin Cardioljournal_title
Current opinion in cardiologyauthors
Dupuis JYdoi
10.1097/HCO.0b013e32831217edsubject
Has Abstractpub_date
2008-11-01 00:00:00pages
560-7issue
6eissn
0268-4705issn
1531-7080pii
00001573-200811000-00007journal_volume
23pub_type
杂志文章,评审abstract:PURPOSE OF REVIEW:Vitamin D deficiency is common throughout the world, with a particularly high prevalence in northern latitudes and colder climates. Although the best known sequelae of vitamin D deficiency involve the musculoskeletal system, a growing body of evidence suggests that vitamin D status may influence cardi...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0b013e32833cd491
更新日期:2010-09-01 00:00:00
abstract::Recent evidence indicates that infections or a pathogen burden contribute to the development and progression of atherosclerosis. While the mechanism of infection contributing to the pathogenesis is not fully elucidated, I hypothesize that heat shock proteins may be a link between infections and atherosclerosis. Heat s...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/00001573-200307000-00001
更新日期:2003-07-01 00:00:00
abstract:PURPOSE OF REVIEW:Patients with tetralogy of Fallot are subject to arrhythmic sequelae that substantially impact morbidity and mortality. This review focuses on recent advances in our understanding of the prevalence and types of arrhythmias encountered. Diagnostic and prognostic tools are considered and therapeutic opt...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0b013e328341381a
更新日期:2011-01-01 00:00:00
abstract:PURPOSE OF REVIEW:This review demonstrates the need for enhancing strategic approaches to the prevention and control of hypertension, a global health issue. RECENT FINDINGS:An epidemic of chronic noncommunicable diseases is threatening national healthcare systems' sustainability and the economy of many countries. Incr...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0000000000000067
更新日期:2014-07-01 00:00:00
abstract::There has been an intensive effort in the past year to identify immunologic and nonimmunologic factors in the pathogenesis of cardiac allograft vasculopathy. Significant progress has been made regarding cell proliferation and cell death, with particular focus on cell growth factors, cell death factors, and their recep...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/00001573-199603000-00012
更新日期:1996-03-01 00:00:00
abstract:PURPOSE OF REVIEW:The purpose of this review is to highlight recent advances in the field of exercise testing for patients with heart failure. RECENT FINDINGS:The importance of assessment of cardiorespiratory fitness (CRF) and exercise testing in heart failure is highlighted in the consensus recommendation of the Amer...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0000000000000490
更新日期:2018-03-01 00:00:00
abstract:PURPOSE OF REVIEW:The purpose of the review is to provide an update on the safety and efficacy of catheter cryoablation. RECENT FINDINGS:Catheter cryoablation is a safe and clinically effective method for ablation of atrioventricular nodal reentrant supraventricular tachycardia. Although the acute procedural success r...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:
更新日期:2005-01-01 00:00:00
abstract:PURPOSE OF REVIEW:The aim of this review is to focus specifically on the indications, evolution of technique, and results of surgical ablation for atrial fibrillation. RECENT FINDINGS:With the introduction of the Cox-Maze IV procedure utilizing bipolar radiofrequency ablation and cryoablation, long-term studies have d...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0000000000000125
更新日期:2015-01-01 00:00:00
abstract:PURPOSE OF REVIEW:Coronary artery disease is common in patients with end-stage renal disease (ESRD) on hemodialysis. ESRD patients are prone to atherosclerosis and are likely to present with advanced CAD requiring coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). RECENT FINDINGS:...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0000000000000539
更新日期:2018-09-01 00:00:00
abstract::Intravenous thrombolysis has become a primary mode of reperfusion therapy for selected patients with acute myocardial infarction. The timing and potential benefits of cardiac angiography and coronary revascularization after thrombolysis in patients experiencing an uncomplicated myocardial infarction have been extensiv...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/00001573-199507000-00007
更新日期:1995-07-01 00:00:00
abstract:PURPOSE OF REVIEW:To summarize changing paradigms and perceptions in the prevention and treatment of cardiovascular disease. RECENT FINDINGS:Recent studies have shown that arterial inflammation probably plays a key role in the development and progression of atherosclerosis, that acute myocardial infarctions often evol...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0b013e32830b360b
更新日期:2008-09-01 00:00:00
abstract::Fewer than 50 pediatric lung transplants are performed each year. Surgical advances in the field have resulted in improved operative outcomes and in technical innovations that have broadened both the target population and the donor pool. At the same time, late referral of critically ill patients and shortage of donor ...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/00001573-199801000-00012
更新日期:1998-01-01 00:00:00
abstract:PURPOSE OF REVIEW:The natural history of cardiogenic shock has improved significantly with the utilization of revascularization and mechanical circulatory support. Despite the interest in identifying new pharmacological agents, the medical therapy to restore perfusion is limited by their side-effects and no solid evide...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0000000000000057
更新日期:2014-05-01 00:00:00
abstract::Assessment of the pulmonary circulation and right ventricular function is a cornerstone in the evaluation of the patient as a potential heart transplant recipient. The importance of pulmonary hypertension is linked to outcomes in the posttransplant period. Preoperative pulmonary vascular resistance is an independent r...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/00001573-200303000-00012
更新日期:2003-03-01 00:00:00
abstract:PURPOSE OF REVIEW:High-density lipoprotein cholesterol (HDL-C) has been well established as an inverse predictor of coronary heart disease (CHD), and in recent years, investigations have focused on the genetic regulation of high-density lipoprotein. Although numerous candidate genes contribute to the low HDL-C phenotyp...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/01.hco.0000126584.12520.b5
更新日期:2004-07-01 00:00:00
abstract::Venous graft disease is a thromboproliferative process and places a serious limitation on the symptom-free survival of patients after coronary artery bypass grafting. The efficacy of antithrombotics, especially during the first year after surgery, is suggested by an understanding of the four described phases of diseas...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/00001573-199811000-00012
更新日期:1998-11-01 00:00:00
abstract:PURPOSE OF REVIEW:Heart failure and diabetes mellitus are frequently associated, and diabetes appears to potentiate the clinical presentation of heart failure related to other causes. The purpose of this review is to examine recent advances in the application of tissue Doppler imaging for the assessment of diabetic hea...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/01.hco.0000131535.32657.87
更新日期:2004-09-01 00:00:00
abstract:PURPOSE OF REVIEW:Cardiac magnetic resonance imaging has an expanding role as a preferred modality for the detection and characterization of myocardial viability. RECENT FINDINGS:Improving the accuracy of cardiac magnetic resonance for detecting viable myocardium has been one focus of investigators. In segments with i...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/01.hco.0000240584.68720.ae
更新日期:2006-09-01 00:00:00
abstract:PURPOSE OF REVIEW:Primary cardiac tumors are a rare disease, which may have severe clinical consequences. Malignant tumors may be misdiagnosed as mixomas, with improper treatment. The aim of this review is to report how to make a differential diagnosis using old and modern tools, the latest trends in tumor classificati...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0000000000000335
更新日期:2016-11-01 00:00:00
abstract:PURPOSE OF REVIEW:To review current controversies in the transcatheter device closure of ostium secundum atrial septal defects (ASD). RECENT FINDINGS:Transcatheter device closure of ASD (TC-ASD) has well established efficacy and safety. For most individual patients with suitable anatomy, TC-ASD is the preferred method...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0000000000000476
更新日期:2018-01-01 00:00:00
abstract:PURPOSE OF REVIEW:The intra-aortic balloon pump (IABP) has been used as a cardiac assist device in various clinical situations since 1968 on the basis of the physiological principles and observational data, with little randomized data until recently. RECENT FINDINGS:Recently published randomized controlled trials (RCT...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0000000000000075
更新日期:2014-07-01 00:00:00
abstract:PURPOSE OF REVIEW:Device therapy for atrial fibrillation remains contentious despite the recognized benefit of atrial pacing in sinus node dysfunction. There are various new specialized pacing algorithms that aim to provide rhythm or rate control in atrial fibrillation. We review the various options for device therapy ...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/01.hco.0000210302.56736.60
更新日期:2006-03-01 00:00:00
abstract::The therapeutic benefits of angiotensin-converting enzyme inhibitors in the treatment of hypertension, congestive heart failure, and atherosclerotic heart disease are undeniable. Recent studies, however, suggest that the cardioprotective effect produced by these drugs is complex and may not be solely related to inhibi...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/00001573-199409000-00004
更新日期:1994-09-01 00:00:00
abstract::Magnetic resonance imaging of the cardiovascular system is now a well-recognized primary investigative technique for many conditions of structural abnormality in clinical cardiology, but the assessment of functional abnormality is also valuable and is increasingly being recognized by clinicians because of the accuracy...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/00001573-199611000-00013
更新日期:1996-11-01 00:00:00
abstract::Clinical work in cardiac transplantation has focused on combating the major complications of this procedure, namely graft rejection and infection. Retrospective analyses suggest that prospective HLA typing, as is done in renal transplantation, may improve patient survival. Trials using FK 506 in cardiac transplantati...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/00001573-199303000-00016
更新日期:1993-03-01 00:00:00
abstract::Although activation of the endocrine renin-angiotensin system with consequent vasoconstriction and salt retention have long been known as the hallmarks of the early phase of renovascular hypertension, the recent recognition of a local vascular angiotensin system and the understanding of the process of vascular remodel...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/00001573-199409000-00015
更新日期:1994-09-01 00:00:00
abstract:PURPOSE OF REVIEW:Although arterial hypertension is less common in children than in adults, there is growing concern about elevated blood pressure (BP) in children and adolescents not only because of the association of elevated values with the overweight epidemic, but also as cardiovascular functions are determined in ...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0000000000000191
更新日期:2015-07-01 00:00:00
abstract:PURPOSE OF REVIEW:The presence of tricuspid regurgitation in the setting of right ventricular dysfunction is associated with poor prognosis. The purpose of this review is to describe the pathophysiology of functional tricuspid regurgitation, summarize the current reports favoring a more aggressive approach toward tricu...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0b013e3283512051
更新日期:2012-05-01 00:00:00
abstract:PURPOSE OF REVIEW:Advanced heart failure is a chronic, systemic disease, which affects other organs in ways that are incompletely understood. Patients with advanced heart failure commonly develop congestive hepatopathy, which may lead to progressive hepatic injury and fibrosis. Because the independent adverse effects o...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0000000000000288
更新日期:2016-05-01 00:00:00
abstract:PURPOSE OF REVIEW:Thrombus formation, usually on a ruptured atherosclerotic plaque, is pivotal in the pathogenesis of ST segment elevation myocardial infarction (STEMI). This thrombus formation provides the milieu for re-occlusion of the infarct-related artery, the main location of re-infarction post-STEMI. Although ra...
journal_title:Current opinion in cardiology
pub_type: 杂志文章,评审
doi:10.1097/HCO.0000000000000193
更新日期:2015-07-01 00:00:00