ABSTRACT
Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)
Subject(s)
Humans , Cardiovascular Diseases/prevention & control , Nutrition Assessment , Diet, Food, and NutritionABSTRACT
The Timeline Followback (TLFB; L. C. Sobell & M. B. Sobell, 1996) interview, which uses a calendar method developed to evaluate daily patterns and frequency of drinking behavior over a specified time period, has well-established reliability and validity for assessing alcohol consumption. Although several investigators have used the TLFB to evaluate drug-using behavior, few studies have examined the psychometric properties of the interview for this purpose. The authors conducted TLFB interviews with a sample of adult drug-abusing patients seeking treatment for substance abuse (n = 113) at baseline, posttreatment, and quarterly thereafter for 12 months. It was found that the patients' reports about their drug consumption using this method generally had high (a) retest reliability, (b) convergent and discriminant validity with other measures, (c) agreement with collateral informants' reports of patients' substance use, and (d) agreement with results from patients' urine assays.
Subject(s)
Alcoholism/diagnosis , Illicit Drugs , Interview, Psychological , Medical History Taking/statistics & numerical data , Substance-Related Disorders/diagnosis , Adult , Alcoholism/rehabilitation , Female , Humans , Male , Psychometrics , Reproducibility of Results , Self Disclosure , Substance-Related Disorders/rehabilitationABSTRACT
An analysis of the psychological aspects of the legal concept of competency/fitness to stand trial draws attention to the central role of understanding. The rationale of certain basic requirements for the construct validity of a psychometric test of understanding in people with mental retardation is presented, and a test that meets those requirements is described.
