Sumita D. Paul's research while affiliated with Massachusetts General Hospital and other places

Publications (19)

Article
Full-text available
The objective of this study were to assess the impact of a quality assurance effort on the door-to-needle time and the choice of thrombolytic agent for the management of acute myocardial infarction in the emergency department. The study design involved a prospective collection of data on a series of consecutive patients who received a thrombolytic...
Article
In a MEDLINE search of published English studies (1966 to 1996), no prior study was identified that examined gender-based differences in the management and prognosis of patients admitted with syncope. We studied 109 consecutive patients (48 women) admitted with syncope at the Massachusetts General Hospital (1989 to 1990). All patients underwent Hol...
Article
Preoperative clinical indexes to stratify cardiac risk have not been validated angiographically. Our aims were to determine the concordance of clinical risk with severity of coronary stenosis and to develop and validate a preoperative clinical index to exclude the presence of significant coronary stenosis. We carried out a prospective study of 878...
Article
Elderly patients have a higher mortality after acute myocardial infarction (MI) yet are treated less aggressively than younger patients. To determine (l) the risk-factor profiles, (2) presentation, (3) management, and (4) hospital outcomes for the elderly (> or = 75 years) compared with middle aged (66 to 74 years) and younger (< or = 65 years) pat...
Article
Objectives: This study sought to develop and validate a Bayesian risk prediction model for vascular surgery candidates. Background: Patients who require surgical treatment of peripheral vascular disease are at increased risk of perioperative cardiac morbidity and mortality. Existing prediction models tend to underestimate risk in vascular surger...
Article
Objectives. This study sought to determine how noninvasive and invasive cardiologists may differ in the hospital care of patients with acute myocardial infarction.Background. Scant information exists regarding the effect of noninvasive and invasive cardiology subspecialization on invasive cardiac procedural use, cost and outcome in the care of pati...
Article
Previous studies have reported conflicting results on gender differences in the management of acute myocardial infarction (AMI) and have not evaluated hospital length of stay or costs. To determine gender-based differences in presentation, management, length of stay, costs, and prognosis after AMI, we studied 561 patients with AMI. Women were older...
Article
Physicians should adapt a systematic approach to cardiac risk stratification for patients being considered for noncardiac surgery, involving clinical evaluation, functional assessment, and surgical risk assessment for all patients and then deciding which patient needs to undergo noninvasive testing, coronary angiography and revascularization, perio...
Article
Purpose: The evaluation of coronary artery disease (CAD) in patients undergoing vascular surgery can provide information with respect to perioperative and long-term risk for CAD-related events. However, the extent to which the required surgical procedure itself imparts additional risk beyond that dictated by the presence of CAD determinants remain...
Article
Little information is available regarding the occurrence of perioperative and late cardiac events in women with vascular disease. The current study was performed to examine whether sex-specific differences exist in these outcomes in a large population of vascular surgery patients and to determine the value of clinical and dipyridamole thallium vari...
Article
Thrombolytic therapy (TT) clearly saves lives in acute myocardial infarction (MI), but the major limitation to its widespread use has been the large proportion of MI pts considered ineligible for TT. In recent overviews of the large randomized TT trials, net benefit is consistently seen with: 1) ST elevation MI (diagnostic ST elevations in any anat...
Article
Preop evaluation of geriatric pts may identify those at risk for perioperative and long-term cardiac events and a small fraction who could potentially benefit from coronary revascularization prior to vascular surgery (VAS). We have shown that pts with 1 or 2 preop clinical markers (DM, prior MI, Q wave on ECG (QWAVE), angina, age g 70 yrs, CHF) are...
Article
Myocardial ischemia is an indicator of adverse prognosis. In patients with stable angina and positive exercise tests, prolonged cumulative ischemia on ambulatory electrocardiographic monitoring identifies a high-risk group with severe coronary artery disease and poor survival. To determine whether features of the exercise test can accurately (1) pr...

Citations

... A larger multi-centre study, with stratified sampling may help to resolve some of these issues, and it is acknowledged that both geographical and individual consultant factors may confound treatment decisions. For instance there may be a proclivity to perform interventional cardiology in certain regions and/or that individual cardiologists may be referred particular patients, and have preferences for particular treatments [23]. More detailed analysis of such factors with a larger study sample may help to unravel how such factors confound treatment decision processes. ...
... Outcomes were adjusted to account for confounding factors. We adjusted for age (as a continuous variable) given that age is a risk factor for the outcomes of interest, and for sex, which has been shown to impact LOS, costs and in-hospital mortality [18][19][20]. Race was included since racial disparities have been shown for LOS and mortality [19,21]. We controlled for admission status since previous research on this technology made this adjustment in multivariate regressions given the potential for it to impact hospital resource use and outcomes [11]. ...
... The main benefit of these systems is that they do not need extensive training or a computer to be calculated. There are many scoring systems in use today such as SAPS III [365], which predicts the mortality of ICU patients, QRISK2 [366] which is a prediction score for cardiovascular diseases, and Eagle score [367] which gives a probability for a patient dying during heart surgery. ...
... Perioperative MI is associated with high mortality ranging from 26-70% [1][2][3][4][5][6][7]. Therefore, it is imperative to identify patients who are at risk for untoward outcomes after surgery by using a systematic stepwise strategic preoperative evaluation such as that put forward in the guidelines of the ACC/AHA task force [8][9][10][11]. ...
... The leading causes of death and morbidity in adults with major vascular surgical interventions are acute myocardial infarction, cardiac arrhythmias, and acute heart failure [5][6][7][8]. ...
... In cardiovascular disease, a validated difference exists in disease presentation, progress, and outcome between the sexes. [17][18][19] In the presence of carotid artery disease, women have less benefit from CEA compared with men. [1][2][3][4] The underlying pathophysiologic mechanisms that explain these sexspecific differences are poorly understood. ...
... Paul e cols. 17 também demonstraram que o tempo de aparecimento de 21 avaliaram, com a eletrocardiografia dinâmica, trinta pacientes com doença coronária estável e teste ergométrico positivo, também encontrando FC menor no aparecimento da isquemia na eletrocardiografia (98,0±20,5 versus 124,0±17,0 bpm). Embora haja a influência dos fatores determinantes do consumo de oxigênio na gênese dos episódios isquêmicos às atividades habituais, como se depreende do que ocorre durante o teste de esforço, também a sua variação, e não apenas seu valor absoluto, pode determinar isquemia, como se observa na eletrocardiografia de 24 horas. ...
... En otros estudios donde se incluyó población hospitalizada ≥ 65 años se identificaron otros factores de riesgo de mortalidad como los síndromes coronarios agudos, cáncer, insuficiencia renal, hiponatremia 17 , trastornos del potasio 18 , edad 16,19 , trastornos del calcio 20 , alta puntuación del índice de Charlson 21-23 y fragilidad 24 . Sin embargo en este estudio encontramos una asociación independiente entre mortalidad y niveles elevados de vitamina B-12, siendo este riesgo asociado descrito en otros estudios como el "estudio Newcastle 85+" de Mendonça et al (2018) se demostrando relación entre mortalidad por cualquier causa y por causas cardiovasculares, con niveles altos de vitamina B-12 en mujeres de ≥ 85 6 . ...
... Selected 30 male and female individuals' samples (14 critical CAD patients and 16 non-CAD controls) were included in the study. Critical CAD has been defined as ≥ 70% stenosis in ≥ 1 coronary artery while non-CAD is defined as ≤ 20% stenosis in coronary arteries [13]. Following angiography, the Gensini and SYNTAX scores (version 2.28, www. ...
... Our study was comparable to the Italian study in observing a higher prevalence of adverse risk factors among syncope patients hospitalized compared with among patients discharged but further extends this finding specifically to patient's sex. Although, our cohort consisted of patients with a primary discharge diagnosis of syncope, prior studies have found older age and cardiac comorbidities are related to cardiac causes of syncope that are more frequently observed among men whereas noncardiac causes of syncope are often found in women (34)(35)(36). Men have been found to have worse cardiac event-free survival (33) than women who are hospitalized, and male sex has been identified as an independent predictor of inhospital or short-term all-cause mortality among hospitalized cohorts (13,27,37,38). After adjusting for confounders, we also found male sex, compared with female sex, is associated with a 1. patients. ...