Intergenerational Decision Making: The Role of Family Relationships in Medical Decision Making.

A symposium held at the 42nd annual Society for Medical Decision Making conference on October 26, 2020, focused on intergenerational decision making. The symposium covered existing research and clinical experiences using formal presentations and moderated discussion and was attended by 43 people. Presentations focused on the roles of pediatric patients in decision making, caregiver decision making for a child with complex medical needs, caregiver involvement in advanced care planning, and the inclusion of spillover effects in economic evaluations.

Pregnancy-Associated Spontaneous Coronary Artery Dissection: Clinical Characteristics, Outcomes, and Risk During Subsequent Pregnancy.

Objectives: Spontaneous coronary artery dissection (SCAD) is a common cause of pregnancy-associated myocardial infarction.

Methods: This study compares the clinical course and longitudinal follow-up of 22 cases of pregnancy-associated SCAD (P-SCAD) with 285 cases of non-pregnancy SCAD (NP-SCAD) from Kaiser Permanente Northern California between September 2002 through June 2017.

Results: Age in the P-SCAD group was significantly lower than in the NP-SCAD group (37.

Spontaneous Coronary Artery Dissection: Clinical Characteristics, Management, and Outcomes in a Racially and Ethnically Diverse Community-Based Cohort.

Context: Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome, which predominantly affects healthy women; however, few data define this vulnerable population.

Objective: To identify demographic and clinical characteristics of patients with SCAD and determine outcomes in a community-based cohort.

Design: Retrospective cohort study of patients with SCAD at Kaiser Permanente Northern California during a 10-year period.

Effectiveness of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease.

The optimal coronary revascularization strategy (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI]) in patients with end-stage renal disease (ESRD) remains uncertain. We performed an updated systematic review and meta-analysis of observational studies comparing CABG and PCI in patients with ESRD using a random-effects model for the primary outcome of long-term all-cause mortality. Our review registered through PROSPERO included observational studies published after 2011 to ensure overlap with previous studies and identified 7 new studies for a total of 23.

Spontaneous Coronary Artery Dissection with Cardiac Tamponade.

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Clinical presentation ranges from chest pain alone to ST-segment-elevation myocardial infarction, ventricular fibrillation, and sudden death. The treatment of patients with spontaneous coronary artery dissection is challenging because the disease pathophysiology is unclear, optimal treatment is unknown, and short- and long-term prognostic data are minimal.

Comparing Anxiety and Depression in Patients With Takotsubo Stress Cardiomyopathy to Those With Acute Coronary Syndrome.

Purpose: To determine whether anxiety or depression is associated with takotsubo stress cardiomyopathy (TSCM).

Methods: A retrospective case-control study was conducted among 73 TSCM cases and 111 acute coronary syndrome (ACS) controls matched for age, sex, and cardiac catheterization date. The study was conducted between May 1, 2009, and February 28, 2010.

Impact of stenting technique and bifurcation anatomy on long-term outcomes of PCI for distal unprotected left main coronary disease.

Objectives: We aimed to assess the associations of stenting strategy and bifurcation anatomy with outcomes of percutaneous coronary intervention (PCI) for distal unprotected left main (ULM) coronary disease.

Background: There are limited and conflicting data regarding long-term outcomes associated with stenting strategies for PCI of distal ULM coronary disease.

Methods: Patients undergoing non-emergent PCI for distal ULM coronary disease comprised the study cohort.

Finding similar 2D X-ray coronary angiograms.

In clinical practice, physicians often exploit previously observed patterns in coronary angiograms from similar patients to quickly assess the state of the disease in a current patient. These assessments involve visually observed features such as the distance of a junction from the root and the tortuosity of the arteries. In this paper, we show how these visual features can be automatically extracted from coronary artery images and used for finding similar coronary angiograms from a database.

Surgical candidacy and selection biases in nonemergent left main stenting: implications for observational studies.

Objectives: This study sought to characterize reasons for surgical ineligibility in patients undergoing nonemergent unprotected left main (ULM) percutaneous coronary intervention (PCI) and to assess the potential for these reasons to confound comparative effectiveness studies of coronary revascularization.

Background: Although both PCI and coronary artery bypass graft surgery are treatments for ULM disease, some patients are not eligible for both treatments, which may result in treatment selection biases.

Methods: In 101 consecutive patients undergoing nonemergent ULM PCI, mixed methods were used to determine the prevalence of treatment selection dictated by surgical ineligibility and to identify the reasons cited for avoiding coronary artery bypass graft surgery.

Coronary stent infections: a case series.

Stent infection is a rare sequela of coronary stent implantation first reported fifteen years ago. Since that time, much has been learned about this dramatic disease entity by way of case report and review. Nevertheless, clinical experience with regard to the diagnosis and management of coronary artery stent infection remains limited.

Heart Failure Etiology Is Usually Pluricausal Whether or Not There is Associated Coronary Disease.

The heart failure syndrome (HF) has diverse etiologies. In a 22-year study of predictors of HF in 126,235 persons, we attempted to identify etiologic factors independent of associated coronary heart disease (CAD) in 2594 persons hospitalized for the condition. For this purpose, subjects were stratified according to whether CAD was present.

Alcohol drinking and risk of hospitalization for heart failure with and without associated coronary artery disease.

Myocardial damage from heavy alcohol intake can cause the heart failure (HF) syndrome, but the relation of lighter alcohol intake to HF has rarely been studied. We examined the risk of HF hospitalization among 126,236 subjects who supplied data about alcohol during health examinations from 1978 to 1985. Among 2,594 subjects who were subsequently hospitalized for HF, record review established an association between coronary artery disease (CAD) and HF (CAD-HF) in 1,559 patients.