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Articles by D. E Forman
Total Records ( 2 ) for D. E Forman
  D. E Forman , D. A Cox , S. G Ellis , J. M Lasala , J. A Ormiston , G. W Stone , M. A Turco , J. Y Wei , A. A Joshi , K. D Dawkins and D. S. Baim
 

Background— Although drug-eluting stents have become a mainstay of percutaneous coronary intervention, information about drug-eluting stents outcomes in elderly patients is limited. Data from the paclitaxel-eluting stent (PES) trials and registries were pooled to assess PES benefits relative to advancing patient age, including comparison with bare-metal stents.

Methods and Results— Data from 5 randomized trials (2271 patients with PES, 1397 patients with bare-metal stents) and from 2 postmarket registries (7492 patients with PES) were pooled separately. Each dataset was stratified into age groups: <60, 60 to 70, and >70 years. At baseline, patients aged >70 years in both datasets had significantly more adverse characteristics than younger patients. Through 5 years, trial data showed that patients aged >70 years had higher death rates, but comparable rates of myocardial infarction, stent thrombosis, and target lesion revascularization with younger patients. Compared with patients with bare-metal stents, patients with PES aged >70 years had comparable rates of death, myocardial infarction, and stent thrombosis but a significantly lower target lesion revascularization rate (22.2 versus 10.2, P<0.001). These findings were echoed in the registry data through 2 years that showed that PES patients aged >70 years had significantly higher death rates, but lower myocardial infarction, stent thrombosis, and target lesion revascularization rates, compared with younger patients. Although the mortality rates of patients aged >70 years were higher than those of younger patients, they were comparable with those of age- and gender-matched norms in the general population.

Conclusions— This analysis of almost 10 000 patients demonstrated that percutaneous coronary intervention with PES is a safe and an effective treatment option that should not be withheld based on age.

  R Arena , J Myers , J Abella , S Pinkstaff , P Brubaker , D Kitzman , M. A Peberdy , D Bensimhon , P Chase , D. E Forman and M. Guazzi
  Background—

Ventilatory efficiency (Ve/Vco2 slope) and peak oxygen consumption (Vo) provide robust prognostic information in patients with heart failure undergoing cardiopulmonary exercise testing (CPX). The purpose of this study is to assess the change in prognostic characteristics of CPX at different time intervals.

Methods and Results—

Seven hundred ninety-one subjects (74%male, mean age: 60.7±12.9 years, ejection fraction: 34.6±15.0%, ischemic etiology: 51%) underwent CPX and were tracked for major cardiac events over a 4-year period. All event-free subjects were tracked for at least 3 years. Mean Ve/Vco2 slope and peak Vo2 were 35.0±10.0 and 16.0±6.4 mL O2 · kg–1 · min–1, respectively. There were a total of 263 major cardiac events (199 deaths, 45 transplants, and 19 left ventricular assist device implantations). Both continuous and dichotomous expressions of the Ve/Vco2 slope and peak Vo2 were prognostically significant up to 18 months post-CPX. Continuous and dichotomous expressions of the Ve/Vco2 slope remained prognostically significant up to 36 months post-CPX, whereas peak Vo2 was not predictive during the third and fourth year of follow-up. In a multivariate analysis, the Ve/Vco2 slope was consistently the superior prognostic marker, whereas peak Vo2 added predictive value and was retained in the regression up to 18 months post-CPX.

Conclusions—

These results indicate that commonly assessed CPX variables retain prognostic value for at least 2 years. The Ve/Vco2 slope is the superior predictor of adverse events throughout follow-up, although peak Vo2 provides additive prognostic information during the first 2 years of follow-up.

 
 
 
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