LeRoy LeNarz - Academia.edu (original) (raw)

Papers by LeRoy LeNarz

Circulation: Cardiovascular Quality and Outcomes, 2011

Objective: Diabetes is an independent prognostic factor for increased risk for ischemic heart dis... more Objective: Diabetes is an independent prognostic factor for increased risk for ischemic heart disease. This study evaluates differences in resource utilization and health care costs for acute coronary syndrome (ACS) patients with and without diabetes mellitus (DM). Methods: A retrospective cohort study was conducted using a large US administrative claims database. Patients, ≥65, hospitalized with a primary diagnosis of ACS between 01/01/2007 and 12/31/2007 were identified and categorized into 2 groups: 1) with DM (ACS patients had ≥ 2 outpatient office visits or 1 hospitalization with the DM diagnosis during the 1 year before/within the index hospitalization) and 2) without DM. Patients with complete insurance coverage 1-year pre- and post- index hospitalization were included. Annual health care costs and resource utilization were compared usingChi-square tests for categorical variables and Wilcoxon rank-sum tests for continuous variables (all p

Circulation: Cardiovascular Quality and Outcomes, 2011

Objective: This study compared real-world treatment patterns for ACS patients with and without DM... more Objective: This study compared real-world treatment patterns for ACS patients with and without DM in a cohort of Medicare population. Methods: A retrospective cohort study was conducted using the MarketScan Medicare claims database. Patients aged ≥65 years, hospitalized with a primary diagnosis of ACS between 01/01/2007 and 12/31/2007 were categorized into 2 groups: with and without DM. Patient characteristics, treatment patterns during the index hospitalization, and cardiovascular medications use 12 months pre- and post-index hospitalization were analyzed. (All p

Circulation, 2014

Objectives: We evaluated the impact of prasugrel pretreatment and timing of coronary artery bypas... more Objectives: We evaluated the impact of prasugrel pretreatment and timing of coronary artery bypass grafting (CABG) on clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing CABG based on data from ACCOAST. Methods: We evaluated the impact of troponin, prasugrel pretreatment and CABG timing on clinical outcomes of NSTEMI patients undergoing CABG through 30 days from ACCOAST. Results: CABG patients versus PCI or medically managed patients were more often male, diabetic, had peripheral arterial disease and a higher GRACE score. By randomization assignment, 157 patients received a 30-mg loading-dose of prasugrel before CABG; 157 patients did not. CABG patients were grouped by tertiles of time from randomization to CABG; baseline characteristics in the Table. Patients in the lowest tertile had significantly more events (cardiovascular death, MI, stroke, urgent revascularization or glycoprotein IIb/IIIa bailout) and all TIMI major bleeds than...

Circulation: Cardiovascular Quality and Outcomes, 2011

Background: Statins are considered to play an important role in reducing coronary heart disease (... more Background: Statins are considered to play an important role in reducing coronary heart disease (CHD) risk. There are currently 6 statins available in the U.S. market and more than 193 million statin prescriptions were written in 2008. We sought to examine the prescription patterns of statins among privately insured commercial and Medicare patients in the U.S. Methods: A retrospective analysis was performed using MarketScan Commercial and Medicare data from Jan. 2008 to Dec. 2008. Two cohorts were created: 1) the commercial cohort (CC) and 2) the Medicare cohort (MC). Statin scripts of minimum 30 day supply were extracted from the pharmacy claims data and individual demographic and clinical information were linked from their medical and administrative records. Prescription patterns of 6 statins were examined and additional analyses by age and gender were performed. Results: There were 18 million and 9.8 million statin prescriptions filled by the CC and MC, respectively. In both coho...

avid E. Kandzari, MD, FACC,* Martin B. Leon, MD, FACC,‡ Jeffrey J. Popma, MD, FACC,§ eter J. Fitz... more avid E. Kandzari, MD, FACC,* Martin B. Leon, MD, FACC,‡ Jeffrey J. Popma, MD, FACC,§ eter J. Fitzgerald, MD, FACC, Charles O’Shaughnessy, MD, FACC,# Michael W. Ball, MD, FACC,** ark Turco, MD, FACC,†† Robert J. Applegate, MD, FACC,† Paul A. Gurbel, MD, FACC,‡‡ ark G. Midei, MD, FACC,§§ Sejal S. Badre, MS,§ Laura Mauri, MD, MSC, FACC,§ weli P. Thompson, MD,¶ LeRoy A. LeNarz, MD,¶ Richard E. Kuntz, MD, FACC,¶ or the ENDEAVOR III Investigators urham and Winston-Salem, North Carolina; New York, New York; Boston, Massachusetts; Palo Alto and anta Rosa, California; Elyria, Ohio; Indianapolis, Indiana; and Takoma Park, Baltimore, and Towson, Maryland

Blood, 2010

1108 Coronary artery bypass grafting (CABG)-related bleeding and associated transfusion support a... more 1108 Coronary artery bypass grafting (CABG)-related bleeding and associated transfusion support are concerns with dual antiplatelet therapy. The amount and the type of blood products transfused may be influenced by patient characteristics, procedural characteristics, acquired hemostatic defects, regional standard of care, and the amount of perioperative blood loss. Withdrawal of clopidogrel 5 days prior or prasugrel 7 days prior to CABG is suggested by the respective product labels to reduce the potential for CABG-related bleeding. Accordingly, a cohort of 422 patients undergoing isolated CABG in TRITON-TIMI 38 (PRASugrel n=208; CLOPidogrel n=214) was analyzed retrospectively to characterize the risk adjusted (using predicted risk of transfusion - Magovern, et al. Ann Thorac Surg 1996;61:27-32) difference in transfusion requirements between prasugrel and clopidogrel. Seventy-six patients who never received study drug or who received open label thienopyridine treatment prior to CABG ...

JACC. Cardiovascular interventions, May 9, 2016

This study assessed whether the choice of vascular access site influenced outcomes among non-ST-s... more This study assessed whether the choice of vascular access site influenced outcomes among non-ST-segment elevation myocardial infarction (NSTEMI) patients enrolled in the ACCOAST (A Comparison of prasugrel at the time of percutaneous Coronary intervention Or as pre-treatment At the time of diagnosis in patients with non-ST-segment elevation myocardial infarction NCT01015287). Transfemoral access (TFA) has been associated with the risk of bleeding and increased mortality that is elevated compared to transradial access (TRA) in acute coronary syndromes, although less consistently in NSTE acute coronary syndrome (NSTE-ACS) than in STE-ACS. The ACCOAST study evaluated a prasugrel loading dose of 60 mg given at the start of percutaneous coronary intervention (PCI) versus a split loading dose of 30 mg given at the time of diagnosis of NSTE-ACS (prior to coronary angiography), followed by 30 mg given at the start of PCI. In the study, choice of access site was at the investigator's disc...

Circulation, Nov 23, 2010

American heart journal, 2015

We evaluated impact of timing of coronary artery bypass grafting (CABG) and prasugrel pretreatmen... more We evaluated impact of timing of coronary artery bypass grafting (CABG) and prasugrel pretreatment in patients with non-ST-segment elevation myocardial infarction undergoing CABG in the ACCOAST study. Of 4033 enrolled patients, 314 (7.8%) underwent isolated CABG through 30 days. Primary efficacy end point for this analysis was any cardiovascular death, myocardial infarction, stroke, urgent revascularization, or glycoprotein IIb/IIIa inhibitor bailout through 30 days. More CABG versus percutaneous coronary intervention or medically managed patients were men, diabetic, or had peripheral arterial disease. Per randomization, 157 of 314 patients received a 30-mg prasugrel loading dose before CABG, and 157 of 314 received placebo. Patients were stratified by tertile of time from randomization to CABG: <2.98 days (n = 104), ≥2.98 and <6.95 days (n = 106), and ≥6.95 days (n = 104). Primary end point occurred in 12.5%, 4.7%, and 4.8%, respectively (<2.98 days vs other tertiles, haza...

Heart (British Cardiac Society), Jan 9, 2015

When considering antiplatelet therapy for acute coronary syndrome (ACS), it is essential to balan... more When considering antiplatelet therapy for acute coronary syndrome (ACS), it is essential to balance benefits (less thrombotic/ischaemic events) versus bleeding risks related to intense platelet inhibition via antagonism of P2Y12 receptors. This analysis aimed to identify predictors of bleeding events among A Comparison of Prasugrel at the Time of PCI or as Pretreatment at the Time of Diagnosis in Patients with NSTEACS (ACCOAST) study population. The ACCOAST study randomised 4033 patients with non-ST-segment elevation myocardial infarction (NSTEMI) to (A) a 30 mg prasugrel loading dose (LD) followed by coronary angiography with an additional 30 mg prasugrel at the time of percutaneous coronary intervention (PCI) or (B) a placebo LD followed by a 60 mg prasugrel at the time of PCI. Patients received standard of care, including use of aspirin. Independent predictors of Thrombolysis in Myocardial Infarction (TIMI) major bleeding not related to coronary artery bypass grafting (CABG) with...

Journal of the American College of Cardiology, Jan 28, 2015

Journal of the American College of Cardiology, Jan 23, 2014

After percutaneous coronary intervention (PCI) for non-ST-segment elevation myocardial infarction... more After percutaneous coronary intervention (PCI) for non-ST-segment elevation myocardial infarction (NSTEMI), treatment with a P2Y12 antagonist with aspirin is recommended for 1 year. The oral P2Y12 antagonists ticagrelor and prasugrel have higher recommendations than clopidogrel, but it is unknown if administration before the start of PCI is beneficial. In the randomized, double-blind ACCOAST (A Comparison of prasugrel at the time of percutaneous Coronary intervention Or as pre-treatment At the time of diagnosis in patients with non-ST-segment elevation myocardial infarction) trial, 4,033 patients were diagnosed with NSTEMI and 68.7% underwent PCI; 1,394 received pre-treatment with prasugrel (30-mg loading dose), and 1,376 received placebo. At the time of PCI, patients who received pre-treatment with prasugrel received an additional 30-mg dose of prasugrel, and those who received placebo received a 60-mg loading dose of prasugrel. Primary efficacy was a composite of cardiovascular de...

Value in Health, 2009

were identified with complete 1-year follow-up eligibility and drug use information in the Market... more were identified with complete 1-year follow-up eligibility and drug use information in the MarketScan claims database. Patients were categorized into two cohorts: DM (N 3040) and non-DM (N 9462). Adherence was measured by the medication possession ratio (MPR). Persistence was reported using the time from index hospitalization to the first gap of 30 days between exhausting the supplied medication and filling the next prescription. Adherence and persistence between cohorts was compared using propensity score-adjusted bootstrapping method. RESULTS: A total of 72.1% (2193/3040) DM patients and 76.1% (7197/9462, p 0.01) non-DM patients had at least 1 outpatient fill for clopidogrel in the 1-year after the index hospitalization. Among the clopidogrel users (64.9% PCI, 30.8% medical management, 4.3% CABG), the average MPR was 0.78 for DM patients and 0.80 for non-DM patients (p 0.189). Significantly lower persistence was observed for DM patients vs. non-DM patients (257.6 vs. 274.7 days, p 0.012). ACS patients undergoing PCI had significantly higher persistence compared to medical management patients (280.7 vs. 231.4 days, p 0.001 for DM; 285.7 vs. 254.6 days, p 0.001 for non-DM). CONCLUSIONS: Approximately three-fourths of patients in this study had used clopidogrel after being hospitalized for ACS. ACS patients with prior diabetic history were less likely to be persistent with medication than non-diabetic ACS patients. This finding might have clinical consequences since DM patients typically have higher risk of cardiac events.

Value in Health, 2011

mendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood ... more mendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood pressure at the baseline stage increased the probability of lack of control in 166%, and per each unit of increase in body mass index the lack of control increased 7%. CONCLUSIONS: CME intervention improved the medical decision-making process to manage hypertension, thus increasing the probability of hypertensive patients to have blood pressure under control.

Value in Health, 2011

mendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood ... more mendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood pressure at the baseline stage increased the probability of lack of control in 166%, and per each unit of increase in body mass index the lack of control increased 7%. CONCLUSIONS: CME intervention improved the medical decision-making process to manage hypertension, thus increasing the probability of hypertensive patients to have blood pressure under control.

The Journal of Thoracic and Cardiovascular Surgery, 2013

Journal of the American College of Cardiology, 2012

Objectives-The objective of this study is to characterize the bleeding, transfusion and other out... more Objectives-The objective of this study is to characterize the bleeding, transfusion and other outcomes of patients related to the timing of prasugrel or clopidogrel withdrawal prior to coronary artery bypass grafting (CABG). Background-There is little evidence to guide clinical decision making regarding the use of prasugrel in patients who may need urgent or emergency CABG. Experience with performing CABG in the presence of clopidogrel has raised concern about perioperative bleeding complications that are unresolved. Methods-A subset of the TRITON TIMI 38 study, where patients with acute coronary syndrome were randomized to treatment with aspirin and either clopidogrel or prasugrel, underwent isolated CABG (N=346). A supplemental case report form was designed and administered, and the data combined with the existing TRITON-TIMI 38 database. Baseline

Journal of the American College of Cardiology, 2006

Circulation: Cardiovascular Quality and Outcomes, 2011

Objective: Diabetes is an independent prognostic factor for increased risk for ischemic heart dis... more Objective: Diabetes is an independent prognostic factor for increased risk for ischemic heart disease. This study evaluates differences in resource utilization and health care costs for acute coronary syndrome (ACS) patients with and without diabetes mellitus (DM). Methods: A retrospective cohort study was conducted using a large US administrative claims database. Patients, ≥65, hospitalized with a primary diagnosis of ACS between 01/01/2007 and 12/31/2007 were identified and categorized into 2 groups: 1) with DM (ACS patients had ≥ 2 outpatient office visits or 1 hospitalization with the DM diagnosis during the 1 year before/within the index hospitalization) and 2) without DM. Patients with complete insurance coverage 1-year pre- and post- index hospitalization were included. Annual health care costs and resource utilization were compared usingChi-square tests for categorical variables and Wilcoxon rank-sum tests for continuous variables (all p

Circulation: Cardiovascular Quality and Outcomes, 2011

Objective: This study compared real-world treatment patterns for ACS patients with and without DM... more Objective: This study compared real-world treatment patterns for ACS patients with and without DM in a cohort of Medicare population. Methods: A retrospective cohort study was conducted using the MarketScan Medicare claims database. Patients aged ≥65 years, hospitalized with a primary diagnosis of ACS between 01/01/2007 and 12/31/2007 were categorized into 2 groups: with and without DM. Patient characteristics, treatment patterns during the index hospitalization, and cardiovascular medications use 12 months pre- and post-index hospitalization were analyzed. (All p

Circulation, 2014

Objectives: We evaluated the impact of prasugrel pretreatment and timing of coronary artery bypas... more Objectives: We evaluated the impact of prasugrel pretreatment and timing of coronary artery bypass grafting (CABG) on clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing CABG based on data from ACCOAST. Methods: We evaluated the impact of troponin, prasugrel pretreatment and CABG timing on clinical outcomes of NSTEMI patients undergoing CABG through 30 days from ACCOAST. Results: CABG patients versus PCI or medically managed patients were more often male, diabetic, had peripheral arterial disease and a higher GRACE score. By randomization assignment, 157 patients received a 30-mg loading-dose of prasugrel before CABG; 157 patients did not. CABG patients were grouped by tertiles of time from randomization to CABG; baseline characteristics in the Table. Patients in the lowest tertile had significantly more events (cardiovascular death, MI, stroke, urgent revascularization or glycoprotein IIb/IIIa bailout) and all TIMI major bleeds than...

Circulation: Cardiovascular Quality and Outcomes, 2011

Background: Statins are considered to play an important role in reducing coronary heart disease (... more Background: Statins are considered to play an important role in reducing coronary heart disease (CHD) risk. There are currently 6 statins available in the U.S. market and more than 193 million statin prescriptions were written in 2008. We sought to examine the prescription patterns of statins among privately insured commercial and Medicare patients in the U.S. Methods: A retrospective analysis was performed using MarketScan Commercial and Medicare data from Jan. 2008 to Dec. 2008. Two cohorts were created: 1) the commercial cohort (CC) and 2) the Medicare cohort (MC). Statin scripts of minimum 30 day supply were extracted from the pharmacy claims data and individual demographic and clinical information were linked from their medical and administrative records. Prescription patterns of 6 statins were examined and additional analyses by age and gender were performed. Results: There were 18 million and 9.8 million statin prescriptions filled by the CC and MC, respectively. In both coho...

avid E. Kandzari, MD, FACC,* Martin B. Leon, MD, FACC,‡ Jeffrey J. Popma, MD, FACC,§ eter J. Fitz... more avid E. Kandzari, MD, FACC,* Martin B. Leon, MD, FACC,‡ Jeffrey J. Popma, MD, FACC,§ eter J. Fitzgerald, MD, FACC, Charles O’Shaughnessy, MD, FACC,# Michael W. Ball, MD, FACC,** ark Turco, MD, FACC,†† Robert J. Applegate, MD, FACC,† Paul A. Gurbel, MD, FACC,‡‡ ark G. Midei, MD, FACC,§§ Sejal S. Badre, MS,§ Laura Mauri, MD, MSC, FACC,§ weli P. Thompson, MD,¶ LeRoy A. LeNarz, MD,¶ Richard E. Kuntz, MD, FACC,¶ or the ENDEAVOR III Investigators urham and Winston-Salem, North Carolina; New York, New York; Boston, Massachusetts; Palo Alto and anta Rosa, California; Elyria, Ohio; Indianapolis, Indiana; and Takoma Park, Baltimore, and Towson, Maryland

Blood, 2010

1108 Coronary artery bypass grafting (CABG)-related bleeding and associated transfusion support a... more 1108 Coronary artery bypass grafting (CABG)-related bleeding and associated transfusion support are concerns with dual antiplatelet therapy. The amount and the type of blood products transfused may be influenced by patient characteristics, procedural characteristics, acquired hemostatic defects, regional standard of care, and the amount of perioperative blood loss. Withdrawal of clopidogrel 5 days prior or prasugrel 7 days prior to CABG is suggested by the respective product labels to reduce the potential for CABG-related bleeding. Accordingly, a cohort of 422 patients undergoing isolated CABG in TRITON-TIMI 38 (PRASugrel n=208; CLOPidogrel n=214) was analyzed retrospectively to characterize the risk adjusted (using predicted risk of transfusion - Magovern, et al. Ann Thorac Surg 1996;61:27-32) difference in transfusion requirements between prasugrel and clopidogrel. Seventy-six patients who never received study drug or who received open label thienopyridine treatment prior to CABG ...

JACC. Cardiovascular interventions, May 9, 2016

This study assessed whether the choice of vascular access site influenced outcomes among non-ST-s... more This study assessed whether the choice of vascular access site influenced outcomes among non-ST-segment elevation myocardial infarction (NSTEMI) patients enrolled in the ACCOAST (A Comparison of prasugrel at the time of percutaneous Coronary intervention Or as pre-treatment At the time of diagnosis in patients with non-ST-segment elevation myocardial infarction NCT01015287). Transfemoral access (TFA) has been associated with the risk of bleeding and increased mortality that is elevated compared to transradial access (TRA) in acute coronary syndromes, although less consistently in NSTE acute coronary syndrome (NSTE-ACS) than in STE-ACS. The ACCOAST study evaluated a prasugrel loading dose of 60 mg given at the start of percutaneous coronary intervention (PCI) versus a split loading dose of 30 mg given at the time of diagnosis of NSTE-ACS (prior to coronary angiography), followed by 30 mg given at the start of PCI. In the study, choice of access site was at the investigator's disc...

Circulation, Nov 23, 2010

American heart journal, 2015

We evaluated impact of timing of coronary artery bypass grafting (CABG) and prasugrel pretreatmen... more We evaluated impact of timing of coronary artery bypass grafting (CABG) and prasugrel pretreatment in patients with non-ST-segment elevation myocardial infarction undergoing CABG in the ACCOAST study. Of 4033 enrolled patients, 314 (7.8%) underwent isolated CABG through 30 days. Primary efficacy end point for this analysis was any cardiovascular death, myocardial infarction, stroke, urgent revascularization, or glycoprotein IIb/IIIa inhibitor bailout through 30 days. More CABG versus percutaneous coronary intervention or medically managed patients were men, diabetic, or had peripheral arterial disease. Per randomization, 157 of 314 patients received a 30-mg prasugrel loading dose before CABG, and 157 of 314 received placebo. Patients were stratified by tertile of time from randomization to CABG: <2.98 days (n = 104), ≥2.98 and <6.95 days (n = 106), and ≥6.95 days (n = 104). Primary end point occurred in 12.5%, 4.7%, and 4.8%, respectively (<2.98 days vs other tertiles, haza...

Heart (British Cardiac Society), Jan 9, 2015

When considering antiplatelet therapy for acute coronary syndrome (ACS), it is essential to balan... more When considering antiplatelet therapy for acute coronary syndrome (ACS), it is essential to balance benefits (less thrombotic/ischaemic events) versus bleeding risks related to intense platelet inhibition via antagonism of P2Y12 receptors. This analysis aimed to identify predictors of bleeding events among A Comparison of Prasugrel at the Time of PCI or as Pretreatment at the Time of Diagnosis in Patients with NSTEACS (ACCOAST) study population. The ACCOAST study randomised 4033 patients with non-ST-segment elevation myocardial infarction (NSTEMI) to (A) a 30 mg prasugrel loading dose (LD) followed by coronary angiography with an additional 30 mg prasugrel at the time of percutaneous coronary intervention (PCI) or (B) a placebo LD followed by a 60 mg prasugrel at the time of PCI. Patients received standard of care, including use of aspirin. Independent predictors of Thrombolysis in Myocardial Infarction (TIMI) major bleeding not related to coronary artery bypass grafting (CABG) with...

Journal of the American College of Cardiology, Jan 28, 2015

Journal of the American College of Cardiology, Jan 23, 2014

After percutaneous coronary intervention (PCI) for non-ST-segment elevation myocardial infarction... more After percutaneous coronary intervention (PCI) for non-ST-segment elevation myocardial infarction (NSTEMI), treatment with a P2Y12 antagonist with aspirin is recommended for 1 year. The oral P2Y12 antagonists ticagrelor and prasugrel have higher recommendations than clopidogrel, but it is unknown if administration before the start of PCI is beneficial. In the randomized, double-blind ACCOAST (A Comparison of prasugrel at the time of percutaneous Coronary intervention Or as pre-treatment At the time of diagnosis in patients with non-ST-segment elevation myocardial infarction) trial, 4,033 patients were diagnosed with NSTEMI and 68.7% underwent PCI; 1,394 received pre-treatment with prasugrel (30-mg loading dose), and 1,376 received placebo. At the time of PCI, patients who received pre-treatment with prasugrel received an additional 30-mg dose of prasugrel, and those who received placebo received a 60-mg loading dose of prasugrel. Primary efficacy was a composite of cardiovascular de...

Value in Health, 2009

were identified with complete 1-year follow-up eligibility and drug use information in the Market... more were identified with complete 1-year follow-up eligibility and drug use information in the MarketScan claims database. Patients were categorized into two cohorts: DM (N 3040) and non-DM (N 9462). Adherence was measured by the medication possession ratio (MPR). Persistence was reported using the time from index hospitalization to the first gap of 30 days between exhausting the supplied medication and filling the next prescription. Adherence and persistence between cohorts was compared using propensity score-adjusted bootstrapping method. RESULTS: A total of 72.1% (2193/3040) DM patients and 76.1% (7197/9462, p 0.01) non-DM patients had at least 1 outpatient fill for clopidogrel in the 1-year after the index hospitalization. Among the clopidogrel users (64.9% PCI, 30.8% medical management, 4.3% CABG), the average MPR was 0.78 for DM patients and 0.80 for non-DM patients (p 0.189). Significantly lower persistence was observed for DM patients vs. non-DM patients (257.6 vs. 274.7 days, p 0.012). ACS patients undergoing PCI had significantly higher persistence compared to medical management patients (280.7 vs. 231.4 days, p 0.001 for DM; 285.7 vs. 254.6 days, p 0.001 for non-DM). CONCLUSIONS: Approximately three-fourths of patients in this study had used clopidogrel after being hospitalized for ACS. ACS patients with prior diabetic history were less likely to be persistent with medication than non-diabetic ACS patients. This finding might have clinical consequences since DM patients typically have higher risk of cardiac events.

Value in Health, 2011

mendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood ... more mendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood pressure at the baseline stage increased the probability of lack of control in 166%, and per each unit of increase in body mass index the lack of control increased 7%. CONCLUSIONS: CME intervention improved the medical decision-making process to manage hypertension, thus increasing the probability of hypertensive patients to have blood pressure under control.

Value in Health, 2011

mendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood ... more mendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood pressure at the baseline stage increased the probability of lack of control in 166%, and per each unit of increase in body mass index the lack of control increased 7%. CONCLUSIONS: CME intervention improved the medical decision-making process to manage hypertension, thus increasing the probability of hypertensive patients to have blood pressure under control.

The Journal of Thoracic and Cardiovascular Surgery, 2013

Journal of the American College of Cardiology, 2012

Objectives-The objective of this study is to characterize the bleeding, transfusion and other out... more Objectives-The objective of this study is to characterize the bleeding, transfusion and other outcomes of patients related to the timing of prasugrel or clopidogrel withdrawal prior to coronary artery bypass grafting (CABG). Background-There is little evidence to guide clinical decision making regarding the use of prasugrel in patients who may need urgent or emergency CABG. Experience with performing CABG in the presence of clopidogrel has raised concern about perioperative bleeding complications that are unresolved. Methods-A subset of the TRITON TIMI 38 study, where patients with acute coronary syndrome were randomized to treatment with aspirin and either clopidogrel or prasugrel, underwent isolated CABG (N=346). A supplemental case report form was designed and administered, and the data combined with the existing TRITON-TIMI 38 database. Baseline

Journal of the American College of Cardiology, 2006