Michael P Hudson

Henry Ford Hospital, Detroit, Michigan, United States

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Publications (69)569.69 Total impact

  • Journal of the American College of Cardiology 03/2015; 65(10):A151. DOI:10.1016/S0735-1097(15)60151-6 · 16.50 Impact Factor
  • Michael P Hudson ·

    Annals of internal medicine 04/2014; 160(8):JC8. DOI:10.7326/0003-4819-160-8-201404150-02008 · 17.81 Impact Factor
  • Ali Shafiq · Phuc Nguyen · Michael P Hudson · Bobak Rabbani ·
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    ABSTRACT: Paragangliomas and pheochromocytomas are catecholamine-secreting tumours which if remain undiagnosed may cause severe morbidity and mortality. In rare circumstances these tumours can cause left ventricular (LV) thrombi to form by inducing cardiomyopathy and subsequent embolic complications. After a thorough literature review, six previous cases were found that presented the formation of an LV thrombus in the setting of a pheochromocytoma or paraganglioma. A majority of these cases were associated with significant wall motion abnormalities and their cardiac ejection fraction (EF) was compromised. This is a rare case of a patient developing LV thrombi in the setting of a paraganglioma with normal cardiac EF. We present this case to compare the similarities and differences of our case with previously reported cases and emphasise the importance of suspecting these LV thrombi in patients with these neuroendocrine tumours.
    Case Reports 11/2013; 2013(nov19_1). DOI:10.1136/bcr-2013-202001
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    ABSTRACT: Wasted health care resources have become a central concern in American health care. Heart failure has one of the highest readmission rates amongst all conditions studied in Medicare/Medicaid populations. The present study was an attempt to cross-sectionally identify correlates of number of past-year admissions and 30-day readmissions in patients with congestive heart failure. Eighty-four patients with congestive heart failure were recruited during hospitalization and underwent a semistructured interview for basic clinical/demographic information and completed several questionnaires measuring depression, anxiety, and spirituality. Depression, history of substance abuse, and history of coronary artery disease displayed borderline results as correlates of past-year admissions. Immediate memory and psychiatric history (positive Patient Health Questionnaire 9, acknowledged history of treatment, and use of an antidepressant per chart) were associated with 30-day readmission rates. Indices of congestive heart failure severity (ejection fraction and last recorded B-type natriuretic peptide level) were not. Present results suggest that both a psychiatric history and cognitive impairment are possible determinants of early readmission.
    Psychosomatics 09/2013; 55(1). DOI:10.1016/j.psym.2013.06.019 · 1.86 Impact Factor
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    ABSTRACT: Eight to ten million individuals are evaluated for chest pain (CP) in Emergency Departments (ED) in the United States each year. CP characteristics are an important factor used to help determine a diagnosis. We studied the relationship between the duration of CP and the diagnosis of acute myocardial infarction (AMI) in patients evaluated in the ED. The study population consisted of a sub-group analysis of a previously published study. The survey population consisted of 1024 consecutive encounters of patients who were evaluated for possible ACS in the ED of Henry Ford Hospital between January and May of 1999, CP duration could be obtained in 426 who were included in this analysis. Of the 426 patients included in the study, 38 (8.9%) had a final diagnosis of AMI, with a median CP duration of 120 minutes (interquartile range, 30-240 minutes), compared with 40 minutes (interquartile range, 6-180 minutes) in patients without AMI (p =0.003). In patients with CP duration less than 5 minutes, there were no AMIs and no deaths at 30 days. There were 10 patients dead at 30 days, with a median CP duration of 180 minutes (interquartile range, 120-1440 minutes) compared to 40 minutes (interquartile range, 10-180 minutes) in patients alive at 30 days (p = 0.011). A longer CP duration and ST depression of 1 mm of less were independently associated with a final diagnosis of AMI. Patients with AMI have longer duration of CP than those without AMI; patients with CP of short duration, less than 5 minutes, are unlikely to have AMI and have a good prognosis at 30 days.
    Critical pathways in cardiology 09/2013; 12(3):150-3. DOI:10.1097/HPC.0b013e31829274ff
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    ABSTRACT: The electrocardiogram's (ECG) ability to aid in the diagnosis and risk stratification of patients with acute coronary syndromes is well established. We sought to investigate the prognostic significance of ECG abnormalities in patients with noncardiac conditions in the emergency department. Patients presenting to the emergency department who were evaluated for possible acute coronary syndrome were consecutively enrolled and an initial ECG was obtained (n = 1024). Only patients with noncardiac diagnoses were reviewed in this analysis (n=493) and 30-month follow-up was obtained. Sinus tachycardia, atrial fibrillation/flutter, ST depression, and left bundle branch block were associated with increased 30-month mortality. After controlling for history of coronary artery disease, age, sex, diabetes mellitus, hypertension, and renal insufficiency, sinus tachycardia and ST-segment depression ≥1 mm were independent predictors of 30-month mortality with a hazard ratio of 2.33 (95% confidence interval, 1.36-4.00; P = 0.002) and 2.49 (95% confidence interval, 1.10-5.67; P = 0.029), respectively. In conclusion, ST-segment depression and sinus tachycardia in patients presenting to the hospital with noncardiac conditions are independently associated with increased 30-month mortality.
    Critical pathways in cardiology 09/2012; 11(3):147-51. DOI:10.1097/HPC.0b013e318259bbff
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    ABSTRACT: Vorapaxar is a new oral protease-activated-receptor 1 (PAR-1) antagonist that inhibits thrombin-induced platelet activation. In this multinational, double-blind, randomized trial, we compared vorapaxar with placebo in 12,944 patients who had acute coronary syndromes without ST-segment elevation. The primary end point was a composite of death from cardiovascular causes, myocardial infarction, stroke, recurrent ischemia with rehospitalization, or urgent coronary revascularization. Follow-up in the trial was terminated early after a safety review. After a median follow-up of 502 days (interquartile range, 349 to 667), the primary end point occurred in 1031 of 6473 patients receiving vorapaxar versus 1102 of 6471 patients receiving placebo (Kaplan-Meier 2-year rate, 18.5% vs. 19.9%; hazard ratio, 0.92; 95% confidence interval [CI], 0.85 to 1.01; P=0.07). A composite of death from cardiovascular causes, myocardial infarction, or stroke occurred in 822 patients in the vorapaxar group versus 910 in the placebo group (14.7% and 16.4%, respectively; hazard ratio, 0.89; 95% CI, 0.81 to 0.98; P=0.02). Rates of moderate and severe bleeding were 7.2% in the vorapaxar group and 5.2% in the placebo group (hazard ratio, 1.35; 95% CI, 1.16 to 1.58; P<0.001). Intracranial hemorrhage rates were 1.1% and 0.2%, respectively (hazard ratio, 3.39; 95% CI, 1.78 to 6.45; P<0.001). Rates of nonhemorrhagic adverse events were similar in the two groups. In patients with acute coronary syndromes, the addition of vorapaxar to standard therapy did not significantly reduce the primary composite end point but significantly increased the risk of major bleeding, including intracranial hemorrhage. (Funded by Merck; TRACER ClinicalTrials.gov number, NCT00527943.).
    New England Journal of Medicine 11/2011; 366(1):20-33. DOI:10.1056/NEJMoa1109719 · 55.87 Impact Factor
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    ABSTRACT: The study purpose is to determine whether numeric and/or graphic ST measurements added to the display of the 12-lead electrocardiogram (ECG) would influence cardiologists' decision to provide myocardial reperfusion therapy. Twenty ECGs with borderline ST-segment deviation during elective percutaneous coronary intervention and 10 controls before balloon inflation were included. Only 5 of the 20 ECGs during coronary balloon occlusion met the 2007 American Heart Association guidelines for ST-elevation myocardial infarction (STEMI). Fifteen cardiologists read 4 sets of these ECGs as the basis for a "yes/no" reperfusion therapy decision. Sets 1 and 4 were the same 12-lead ECGs alone. Set 2 also included numeric ST-segment measurements, and set 3 included both numeric and graphically displayed ST measurements ("ST Maps"). The mean (range) positive reperfusion decisions were 10.6 (2-15), 11.4 (1-19), 9.7 (2-14), and 10.7 (1-15) for sets 1 to 4, respectively. The accuracies of the observers for the 5 STEMI ECGs were 67%, 69%, and 77% for the standard format, the ST numeric format, and the ST graphic format, respectively. The improved detection rate (77% vs 67%) with addition of both numeric and graphic displays did achieve statistical significance (P < .025). The corresponding specificities for the 10 control ECGs were 85%, 79%, and 89%, respectively. In conclusion, a wide variation of reperfusion decisions was observed among clinical cardiologists, and their decisions were not altered by adding ST deviation measurements in numeric and/or graphic displays. Acute coronary occlusion detection rate was low for ECGs meeting STEMI criteria, and this was improved by adding ST-segment measurements in numeric and graphic forms. These results merit further study of the clinical value of this technique for improved acute coronary occlusion treatment decision support.
    Journal of electrocardiology 09/2011; 44(5):502-8. DOI:10.1016/j.jelectrocard.2011.06.009 · 1.36 Impact Factor
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    ABSTRACT: Nesiritide is approved in the United States for early relief of dyspnea in patients with acute heart failure. Previous meta-analyses have raised questions regarding renal toxicity and the mortality associated with this agent. We randomly assigned 7141 patients who were hospitalized with acute heart failure to receive either nesiritide or placebo for 24 to 168 hours in addition to standard care. Coprimary end points were the change in dyspnea at 6 and 24 hours, as measured on a 7-point Likert scale, and the composite end point of rehospitalization for heart failure or death within 30 days. Patients randomly assigned to nesiritide, as compared with those assigned to placebo, more frequently reported markedly or moderately improved dyspnea at 6 hours (44.5% vs. 42.1%, P=0.03) and 24 hours (68.2% vs. 66.1%, P=0.007), but the prespecified level for significance (P≤0.005 for both assessments or P≤0.0025 for either) was not met. The rate of rehospitalization for heart failure or death from any cause within 30 days was 9.4% in the nesiritide group versus 10.1% in the placebo group (absolute difference, -0.7 percentage points; 95% confidence interval [CI], -2.1 to 0.7; P=0.31). There were no significant differences in rates of death from any cause at 30 days (3.6% with nesiritide vs. 4.0% with placebo; absolute difference, -0.4 percentage points; 95% CI, -1.3 to 0.5) or rates of worsening renal function, defined by more than a 25% decrease in the estimated glomerular filtration rate (31.4% vs. 29.5%; odds ratio, 1.09; 95% CI, 0.98 to 1.21; P=0.11). Nesiritide was not associated with an increase or a decrease in the rate of death and rehospitalization and had a small, nonsignificant effect on dyspnea when used in combination with other therapies. It was not associated with a worsening of renal function, but it was associated with an increase in rates of hypotension. On the basis of these results, nesiritide cannot be recommended for routine use in the broad population of patients with acute heart failure. (Funded by Scios; ClinicalTrials.gov number, NCT00475852.).
    New England Journal of Medicine 07/2011; 365(1):32-43. DOI:10.1056/NEJMoa1100171 · 55.87 Impact Factor
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    ABSTRACT: Warfarin is implicated in approximately 30% of reported anticoagulant-related errors. In order to improve anticoagulation management and safety, our institution implemented an inpatient Pharmacist-Directed Anticoagulation Service (PDAS). To evaluate the impact of this service on both transition of care and safety of patients receiving warfarin anticoagulation. Cluster randomized trial. Large, urban teaching hospital and level 1 trauma center. All patients receiving warfarin on two medical and two cardiology units. A PDAS provided dosing, monitoring, and coordination of transition from the inpatient-to-outpatient setting. Endpoints were assessed during hospitalization and 30 days after discharge. Transition of care was considered effective if compliance with all of the transition of care metrics occurred. The transition of care metrics included: appropriate enrollment in the anticoagulation clinic, documented inpatient-to-outpatient provider contact, documented inpatient provider-to-anticoagulation clinic communication and patient follow-up with the anticoagulation clinic within five days of discharge. Safety was measured by the composite endpoint of thromboembolism, major bleeding, or international normalized ratio (INR) ≥5. This study included 500 patients. Transition of care metric compliance occurred in 73% more patients in the PDAS group (P < 0.001). There was also a 32% reduction in the composite safety endpoint in the PDAS group (P = 0.103). This finding was driven by a reduction in rate of INR ≥5 (P = 0.076). Implementation of a PDAS provides a net improvement in quality of care for the patient taking warfarin in the inpatient setting.
    Journal of Hospital Medicine 07/2011; 6(6):322-8. DOI:10.1002/jhm.910 · 2.30 Impact Factor
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    ABSTRACT: Prior studies demonstrate a direct relationship between treatment delays to primary percutaneous intervention and mortality in patients with ST-segment elevation myocardial infarction (STEMI). This analysis compared the relationship of symptom onset-to-balloon time and door-to-balloon time on mortality in patients with STEMI. We analyzed different treatment delays (symptom onset-to-balloon time, door-to-balloon time) and mortality in 5745 STEMI patients. Baseline characteristics, flow grade, 90-day mortality, and clinical outcomes were compared in patients stratified by treatment delay. Multivariable logistic regression modeling was performed to assess the independent and relative effect of each treatment delay on 90-day mortality. Female sex, increased age, and worse thrombolysis in myocardial infarction flow grade were significantly associated with longer symptom onset-to-balloon times and door-to-balloon times. Longer symptom onset-to-balloon time was significantly associated with worse 90-day mortality (3.7%, 4.2%, and 6.5% for time delays <3 hours, 3 to 5 hours, and >5 hours, respectively, P<0.0001). Similarly, longer door-to-balloon times were significantly associated with worse 90-day mortality (3.2%, 4.0%, 4.6%, and 5.3% for delays <60 minutes, 60 to 90 minutes, 90 to 120 minutes, and ≥120 minutes respectively, P<0.0001). In a multivariate model of 90-day mortality, door-to-balloon time (χ(2) 6.0, P<0.014), and symptom onset-to-hospital arrival (χ(2) 9.8, P<0.007) remained independent determinants. Both symptom onset-to-balloon time and hospital door-to-balloon time are strongly associated with 90-day mortality following STEMI. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00091637.
    Circulation Cardiovascular Quality and Outcomes 02/2011; 4(2):183-92. DOI:10.1161/CIRCOUTCOMES.110.945311 · 5.66 Impact Factor
  • João L Cavalcante · Mouaz Al-Mallah · Michael Hudson ·
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    ABSTRACT: Malignant ventricular arrhythmias resulting from isolated right ventricular myocardial infarction (RVMI) without left ventricular myocardial ischaemia or infarction occur rarely. We present a case of a 61 year-old male with acute onset of chest pain and ventricular fibrillation cardiac arrest requiring prompt defibrillation. Subsequent 15-lead EKG, showed ST-segment elevation in the anterior and right precordial leads without ST-segment elevation in the inferior leads. Angiography documented occlusion of a large RV marginal branch. Delayed enhancement cardiac magnetic resonance imaging (DE-CMR) with gadolinium performed two days post-infarct showed isolated RVMI. Patient remained symptom free and haemodynamically stable throughout his hospital stay. The clinical presentation of isolated RV infarct can be misleading and diagnosis difficult. EKG findings can resemble acute anterior wall myocardial infarction, while its course can be accompanied by life-threatening ventricular arrhythmias. This case uniquely combines this rare clinical sequence with DE-CMR images using gadolinium to confirm isolated RVMI. A brief review of RVMI presentation and associated EKG patterns is also discussed.
    Heart, Lung and Circulation 10/2010; 19(10):620-3. DOI:10.1016/j.hlc.2010.05.010 · 1.44 Impact Factor
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    ABSTRACT: Objectives: To evaluate the impact of an inpatient pharmacist-directed anticoagulation service (PDAS) on the safe use of warfarin as patients transition from the inpatient to outpatient setting. Methods: We performed a cluster randomized trial of patients prescribed warfarin on general medical or cardiology inpatient floors. The PDAS provided care to all patients receiving warfarin on one medical and one cardiology floor. Two other similar floors served as controls. Patients admitted with an INR > 3 were excluded from the analysis. Endpoints were assessed 30 days after discharge. Efficacy/safety were measured by the composite endpoint of thromboembolism, major bleeding or INR ≥ 5. Transition of care communication effectiveness was assessed with a communication bundle. The communication bundle included: inpatient-to-outpatient provider contact, inpatient provider-to-anticoagulation clinic communication and patient follow up in the anticoagulation clinic within 5 days of discharge. Communication was considered effective if compliance with all components of the bundle occurred. Results: This analysis included 420 patients (PDAS n = 215, Control n = 205, 23.2% medical, 76.8% cardiology, 29% new to warfarin). Communication bundle compliance occurred in 75% more patients in the PDAS group (p < 0.001). Improvement with PDAS was noted among all components of the communication bundle. There was also a 38% reduction in the composite efficacy/safety endpoint in the PDAS group (p = 0.056). This finding was driven by a reduction in rate of INR ≥ 5 through 30 days after discharge (p = 0.038). Conclusion: Implementation of a PDAS produces improvement in anticoagulant safety and transition of care. Endpoints PDAS Control p-value Communication Bundle 77.6% 2.8% <0.001 Outpatient Provider Communication 99.6% 12.4% <0.001 AC Clinic Communication 98.8% 14.9% <0.001 AC Clinic follow-up within 5 days 78.4% 66.4% 0.003 Composite Efficacy/Safety 10.2% 16.6% 0.056 INR ≥ 5 9.8% 16.6% 0.038 Major Bleeding 0.9% 0.5% 0.590 Thrombosis 0% 0% AC = anticoagulation
    2010 American College of Clinical Pharmacy Spring Practice and Research Forum; 04/2010
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    ABSTRACT: We investigated whether transcutaneous ultrasound (TUS) augments coronary thrombolysis and achieves higher rates of Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 and ST-segment resolution in patients with ST-segment elevation myocardial infarction (STEMI). In animal coronary and peripheral artery thrombosis models, low-frequency TUS enhances and accelerates thrombolysis. In a double-blind, randomized, controlled international clinical trial, 396 patients with STEMI < or =6 h were randomized to thrombolysis alone or thrombolysis plus TUS. The 60 minute TIMI flow grade, ST-segment resolution (primary end points) and other angiographic, electrocardiographic, and clinical outcomes were compared between treatment groups. The trial was halted after Safety and Efficacy Monitoring Committee interim analysis that demonstrated lack of treatment efficacy. In total, 360 patients were evaluable for angiographic, electrocardiographic, or clinical end points. Sixty minutes after thrombolytic administration, the proportion of patients achieving TIMI flow grade 3 did not differ between TUS and control groups (40.7% vs. 48.5%, respectively; p = 0.10). Achievement of >50% ST-segment resolution at 60 min did not differ between TUS and control groups (53.2% vs. 50.0%; p = 0.93). Thirty-day mortality and composite clinical events-death, reinfarction, recurrent ischemia, stroke, major bleed, left ventricular rupture (9.7 % vs. 10.2%; p = 0.88)-did not differ between TUS and control patients. Thrombolysis plus TUS failed to improve 60-min TIMI flow grade or ST-segment resolution versus thrombolysis alone.
    JACC. Cardiovascular Interventions 03/2010; 3(3):352-9. DOI:10.1016/j.jcin.2009.11.020 · 7.35 Impact Factor
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    ABSTRACT: We assessed the incremental value of baseline Q waves over time from symptom onset as a marker of clinical outcome in ST-segment elevation myocardial infarction (STEMI). Time from symptom onset is a central focus in STEMI patients. The presence of Q waves on the baseline electrocardiogram (ECG) has been suggested to be of incremental value to time from symptom onset in evaluating clinical outcomes. We evaluated baseline Q waves and ST-segment resolution 30 min after primary percutaneous intervention (PCI) ECGs in 4,530 STEMI patients without prior infarction. Additionally, peak biomarkers; 90-day mortality; and the composite of death, congestive heart failure (CHF), or cardiogenic shock were assessed. Fifty-six percent of patients had baseline Q waves: they were older, more frequently male and diabetic, and had a more advanced Killip class. Patients with baseline Q waves had greater mortality and a higher composite rate of death, CHF, and shock versus patients without baseline Q waves at 90 days (5.3% vs. 2.1% and 12.1% vs. 4.8%, respectively, both p < 0.001). Complete ST-segment resolution was highest, whereas 90-day mortality and the composite outcome were lowest among those randomized < or =3 h without baseline Q waves. After multivariable adjustment, baseline Q-wave but not time from symptom onset was significantly associated with a 78% relative increase in the hazard of 90-day mortality and a 90% relative increase in the hazard of death, shock, and CHF. Baseline Q waves in STEMI patients treated with primary PCI provide an independent prognostic marker of clinical outcome. These data might be useful in designing future clinical trials as well as in evaluating patients for triage and potential transfer for planned primary PCI. (Pexelizumab in Conjunction With Angioplasty in Acute Myocardial Infarction [APEX-AMI]; NCT00091637).
    Journal of the American College of Cardiology 05/2009; 53(17):1503-9. DOI:10.1016/j.jacc.2009.01.046 · 16.50 Impact Factor
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    ABSTRACT: Atrial fibrillation affects an estimated 2.5 million Americans and incurs an average annual stroke risk of 4.5% per year. Despite warfarin reducing stroke risk by approximately 66%, prior studies show warfarin usage rates to be about 50%. However, the methods that define warfarin as "inappropriate underutilization" might not be sensitive enough to pick up relative contraindications. We assessed the inappropriate underutilization of warfarin in atrial fibrillation patients at our hospital by abstracting individual patient charts. Medical records were reviewed to determine stroke risk factors, warfarin use, and documented contraindications to warfarin use in 364 consecutive patients with atrial fibrillation. Amongst 364 atrial fibrillation patients, 54.6% received warfarin anticoagulation. Overall, 29.5 % of patients had documented reasons for not prescribing warfarin. Primary reasons listed by treating physicians included: gastrointestinal bleed 10.7%, secondary/transient atrial fibrillation 8.2%, and fall risk 6.3%. Only 7.1% of the patients had no documented reasons for the lack of warfarin use. Consistent with previous reports, 45.4% of patients in this atrial fibrillation cohort were not prescribed warfarin. However, after reviewing medical charts for documented reasons why warfarin was not used, the inappropriate underutilization rate was only 7.1%. These findings suggest that studies utilizing administrative database and ICD-9 CM coding might overestimate warfarin underutilization.
    Thrombosis Journal 06/2008; 6(1):6. DOI:10.1186/1477-9560-6-6 · 1.31 Impact Factor
  • Zehra Jaffery · Michael P Hudson · Gordon Jacobsen · Richard Nowak · James McCord ·
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    ABSTRACT: To assess the prognostic utility of the Thrombolysis in Myocardial Infarction (TIMI) risk score in patients in the emergency department (ED) evaluated for possible acute coronary syndrome (ACS). The ability of the TIMI risk score to risk stratify patients at initial presentation in the ED with chest pain of unclear etiology is uncertain. We investigated the prognostic utility of the TIMI risk score in 947 consecutive patients evaluated in the ED for possible ACS. A multivariate analysis was done to evaluate the independent predictive power of the individual components of the TIMI risk score to predict an adverse event at 30 days (all-cause death, myocardial infarction, and coronary revascularization). There were 151 (16%) patients diagnosed with ACS. At 30 days there were 48 (5%) deaths, 84 (9%) myocardial infarctions, and 49 (5%) coronary revascularization procedures. The mean TIMI risk score was significantly higher in patients with an adverse event compared with those without (2.6 +/- 1.3 vs. 1.7 +/- 1.2, P < 0.0001). Four of the 7 TIMI risk factors (age > or = 65 years, ST segment deviation > or = 0.5 mm elevated troponin I, and coronary stenosis > or = 50%) were independently associated with adverse events. A simplified TIMI risk score was computed and was found to have similar prognostic ability as the 7 variable TIMI risk score. A modified TIMI risk score may simplify risk stratification of ED patients with undifferentiated chest pain.
    Journal of Thrombosis and Thrombolysis 10/2007; 24(2):137-44. DOI:10.1007/s11239-007-0013-0 · 2.17 Impact Factor
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    ABSTRACT: The missed diagnosis of acute myocardial infarction has been studied in the Emergency Department, but few studies have investigated how often coronary ischemia is correctly identified in the outpatient setting. This was a single center retrospective observational study of patients with Health Alliance Plan medical insurance hospitalized at a US tertiary center with acute myocardial infarction in 2004. Outpatient encounters in the 30 days preceding acute myocardial infarction were reviewed by two independent cardiologists for presenting symptoms and diagnostic decision-making in order to classify patient presentations as acute coronary ischemia, stable angina or neither. There were 331 patients with acute myocardial infarction, including 190 (57%) with a primary diagnosis of AMI and evaluated by a physician in the preceding 30 days. This group included 68 patients with 95 documented outpatient encounters by a primary care physician, cardiologist, or other internal medicine specialist which formed the final study population. Mean interval between these encounters and AMI was 17 +/- 11 days. Of these patients, 7 (10%) had symptoms of acute coronary ischemia, 5 (7%) had stable angina symptoms, and 56 (83%) had no symptoms of coronary ischemia at their outpatient encounters. Of the 7 patients with acute coronary ischemic symptoms, 5 were correctly identified and 2 were misidentified. A majority of patients with subsequent AMI visit an outpatient provider in the month preceding AMI. However, few present with symptoms of coronary ischemia in the outpatient setting (10%) and these symptoms are not always identified as such.
    Journal of Thrombosis and Thrombolysis 10/2007; 27(1):18-23. DOI:10.1007/s11239-007-0153-2 · 2.17 Impact Factor
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    ABSTRACT: Many providers have implemented specialized lipid clinics to more effectively identify, monitor, and treat hyperlipidemia in patients with coronary artery disease. The effectiveness of such a strategy is not known. We sought to investigate whether a specialized clinic achieves better lipid results and clinical outcomes than standard care. A total of 1233 patients who had coronary disease documented by coronary angiography were randomized to lipid clinic or standard care groups by their providers and followed for 2 years. The primary end point was a composite of death, myocardial infarction, repeat revascularization, and stroke. Lipid clinic (n=617) and standard care (n=616) groups had no significant baseline differences. After 2 years, the lipid clinic group had similar total cholesterol (166+/-42 mg/dL vs 166+/-41 mg/dL, P=.83), low-density lipoprotein cholesterol levels (84+/-32 vs 85+/-32, P=.28), and percentage of patients with low-density lipoprotein cholesterol less than 100 mg/dL (77.5% vs 77.6%, P=.97). There were no significant differences in the primary end point (12.3% vs 11.4%, P=.60) and mortality (7.6% vs 7.3%, P=.80) between the lipid clinic and standard care groups. In patients identified by diagnostic coronary angiography and managed within a single health care system, implementation of a specialized lipid clinic did not achieve greater attainment of hyperlipidemia treatment goals or improved cardiac outcomes.
    The American journal of medicine 09/2007; 120(8):734.e11-7. DOI:10.1016/j.amjmed.2006.06.048 · 5.00 Impact Factor
  • Mouaz Al-Mallah · Rasha N Bazari · Michelle Jankowski · Michael P Hudson ·
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    ABSTRACT: Potent antiplatelet and anticoagulant agents along with early revascularization are increasingly used in patients hospitalized with acute coronary syndromes (ACS). An important complication associated with these therapies is gastrointestinal bleeding (GIB); yet, the predictors, optimal management, and outcomes associated with GIB in ACS patients are poorly studied. We investigated the incidence, predictors, pathological findings, and clinical outcomes associated with GIB in patients with ACS hospitalized at a United States tertiary center between 1996 and 2001. Three percent (80/3,045) of ACS patients developed clinically significant GIB. Predictors of GIB were older age, female gender, non-smoking status, peak troponin I, and prior heart failure, diabetes, or hypertension. Patients with GIB were more critically ill with lower blood pressure and higher heart rates. GIB was associated with an increased need for transfusion, mechanical ventilation, and inotropes/pressors. In-hospital mortality was significantly higher in ACS patients with versus without GIB (36% vs. 5%, P < 0.001). Thirty patients (38%) with GIB underwent endoscopy with no procedural complications of death, arrhythmia, urgent ischemia, or hemodynamic deterioration. In patients with ACS, GIB is associated with older age, female sex, peak troponin I, non-smoking status, diabetes, hypertension, and heart failure. Hospital mortality is increased eightfold when ACS patients experience GIB. More studies are needed to establish the safety of and optimal timing of endoscopy in these patients.
    Journal of Thrombosis and Thrombolysis 02/2007; 23(1):51-5. DOI:10.1007/s11239-006-9005-8 · 2.17 Impact Factor

Publication Stats

2k Citations
569.69 Total Impact Points


  • 2002-2014
    • Henry Ford Hospital
      • Department of Internal Medicine
      Detroit, Michigan, United States
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
  • 1999-2005
    • Duke University Medical Center
      • • Department of Medicine
      • • Division of Cardiology
      • • Duke Clinical Research Institute
      Durham, North Carolina, United States
  • 2004
    • Metropolitan Heart and Vascular Institute
      Minneapolis, Minnesota, United States
  • 2003-2004
    • Henry Ford Health System
      • • Henry Ford Heart and Vascular Institute
      • • Department of Emergency Medicine
      Detroit, Michigan, United States