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Sleeper, Lynn

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Sleeper, Lynn

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    Neighborhood Socioeconomic Status and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Data Set
    (John Wiley and Sons Inc., 2018) Bucholz, Emily; Sleeper, Lynn; Newburger, Jane
    Background: Children with single ventricle heart disease require frequent interventions and follow‐up. Low socioeconomic status (SES) may limit access to high‐quality care and place these children at risk for poor long‐term outcomes. Methods and Results: Data from the SVR (Pediatric Heart Network Single Ventricle Reconstruction Trial Public Use) data set were used to examine the relationship of US neighborhood SES with 30‐day and 1‐year mortality or cardiac transplantation and length of stay among neonates undergoing the Norwood procedure (n=525). Crude rates of death or transplantation at 1 year after Norwood were highest for patients living in neighborhoods with low SES (lowest tertile 37.0% versus middle tertile 31.0% versus highest tertile 23.6%, P=0.024). After adjustment for patient demographics, birth characteristics, and anatomy, patients in the highest SES tertile had significantly lower risk of death or transplant than patients in the lowest SES tertile (hazard ratio 0.62, 95% confidence interval, 0.40, 0.96). When SES was examined continuously, the hazard of 1‐year death or transplant decreased steadily with increasing neighborhood SES. Hazard ratios for 30‐day transplant‐free survival and 1‐year transplant‐free survival were similar in magnitude. There were no significant differences in length of stay following the Norwood procedure by SES. Conclusions: Low neighborhood SES is associated with worse 1‐year transplant‐free survival after the Norwood procedure, suggesting that socioeconomic and environmental factors may be important determinants of outcome in critical congenital heart disease. Future studies should investigate aspects of SES and environment amenable to intervention. Clinical Trial Registration URL:http://www.clinicaltrials.gov> http://www.clinicaltrials.gov. Unique identifier: NCT00115934.
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    One-Year Survival Following Early Revascularization for Cardiogenic Shock
    (American Medical Association (AMA), 2001) Hochman, Judith S.; Sleeper, Lynn; White, Harvey D.; Dzavik, Vladimir; Wong, S. Chiu; Menon, Venu; Webb, John G.; Steingart, Richard; Picard, Michael; Menegus, Mark A.; Boland, Jean; Sanborn, Timothy; Buller, Christopher E.; Modur, Sharada; Forman, Robert; Desvigne-Nickens, Patrice; Jacobs, Alice K.; Slater, James N.; LeJemtel, Thierry H.
    Context Cardiogenic shock (CS) is the leading cause of death for patients hospitalized with acute myocardial infarction (AMI). Objective To assess the effect of early revascularization (ERV) on 1-year survival for patients with AMI complicated by CS. Design The SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) Trial, an unblinded, randomized controlled trial from April 1993 through November 1998. Setting Thirty-six referral centers with angioplasty and cardiac surgery facilities. Patients Three hundred two patients with AMI and CS due to predominant left ventricular failure who met specified clinical and hemodynamic criteria. Interventions Patients were randomly assigned to an initial medical stabilization (IMS; n = 150) group , which included thrombolysis (63% of patients), intra-aortic balloon counterpulsation (86%), and subsequent revascularization (25%), or to an ERV group (n = 152), which mandated revascularization within 6 hours of randomization and included angioplasty (55%) and coronary artery bypass graft surgery (38%). Main Outcome Measures All-cause mortality and functional status at 1 year, compared between the ERV and IMS groups. Results One-year survival was 46.7% for patients in the ERV group compared with 33.6% in the IMS group (absolute difference in survival, 13.2%; 95% confidence interval [CI], 2.2%-24.1%; P<.03; relative risk for death, 0.72; 95% CI, 0.54-0.95). Of the 10 prespecified subgroup analyses, only age (<75 vs ≥ 75 years) interacted significantly (P<.03) with treatment in that treatment benefit was apparent only for patients younger than 75 years (51.6% survival in ERV group vs 33.3% in IMS group). Eighty-three percent of 1-year survivors (85% of ERV group and 80% of IMS group) were in New York Heart Association class I or II. Conclusions For patients with AMI complicated by CS, ERV resulted in improved 1-year survival. We recommend rapid transfer of patients with AMI complicated by CS, particularly those younger than 75 years, to medical centers capable of providing early angiography and revascularization procedures. Cardiogenic shock (CS) is the leading cause of death for patients hospitalized with acute myocardial infarction (AMI), and mortality remains high during the following year. The SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) Trial demonstrated a nonsignificant reduction in 30-day mortality (56% vs 47%) when early revascularization (ERV) was compared with a strategy of initial medical stabilization (IMS), with a larger difference between the groups at 6 months. In this article, we report the 1-year survival, a prespecified secondary end point of the SHOCK Trial.
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    Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock
    (New England Journal of Medicine (NEJM/MMS), 1999) Hochman, Judith S.; Sleeper, Lynn; Webb, John G.; Sanborn, Timothy A.; White, Harvey D.; Talley, J. David; Buller, Christopher E.; Jacobs, Alice K.; Slater, James N.; Col, Jacques; McKinlay, Sonja M.; Picard, Michael; Menegus, Mark A.; Boland, Jean; Dzavik, Vladimir; Thompson, Christopher R.; Wong, S. Chiu; Steingart, Richard; Forman, Robert; Aylward, Philip E.; Godfrey, Emilie; Desvigne-Nickens, Patrice; LeJemtel, Thierry H.
    Background The leading cause of death in patients hospitalized for acute myocardial infarction is cardiogenic shock. We conducted a randomized trial to evaluate early revascularization in patients with cardiogenic shock. Methods Patients with shock due to left ventricular failure complicating myocardial infarction were randomly assigned to emergency revascularization (152 patients) or initial medical stabilization (150 patients). Revascularization was accomplished by either coronary-artery bypass grafting or angioplasty. Intraaortic balloon counterpulsation was performed in 86 percent of the patients in both groups. The primary end point was mortality from all causes at 30 days. Six-month survival was a secondary end point. Results The mean (±SD) age of the patients was 66±10 years, 32 percent were women, and 55 percent had been transferred from other hospitals. The median time to the onset of shock was 5.6 hours after infarction, and most infarcts were anterior in location. Ninety-seven percent of the patients assigned to revascularization underwent early coronary angiography, and 87 percent underwent revascularization; only 2.7 percent of the patients assigned to medical therapy crossed over to early revascularization without clinical indication. Overall mortality at 30 days did not differ significantly between the revascularization and medical-therapy groups (46.7 percent and 56.0 percent, respectively; difference, ¡9.3 percent; 95 percent confidence interval for the difference, ¡20.5 to 1.9 percent; P=0.11). Six-month mortality was lower in the revascularization group than in the medical-therapy group (50.3 percent vs. 63.1 percent, P=0.027). Conclusions In patients with cardiogenic shock, emergency revascularization did not significantly reduce overall mortality at 30 days. However, after six months there was a significant survival benefit. Early revascularization should be strongly considered for patients with acute myocardial infarction complicated by cardiogenic shock. (N Engl J Med 1999;341:625-34.)
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    The relative importance and interactions of CMR-derived parameters of ventricular mechanics in the prediction of death and transplant late after the Fontan operation
    (BioMed Central, 2016) Rathod, Rahul; Sleeper, Lynn; Ghelani, Sunil; Keenan, Ellen M; Harrild, David; Powell, Andrew; Geva, Tal