Journal and News Scan

Shanker Vedantam interviews Jason Hockenberry, an economist at Emory University, regarding recent research into patient behavior following PCI or CABG.  CABG patients were more likely to quit smoking after intervention for CAD.  This may be a result of the magnitude of the intervention, and has implications for improving smoking cessation programs.

Goldberg and colleagues provide an excellent review on a complex topic:  intramural hematomas.  The article has several take-home messages:  one must be very careful in how one defines IMH; its pathogenesis remains unclear; IMH tends to involve a more outer location of the aortic media than aortic dissections (AD) do;  IMH is more likely to rupture externally than AD; risk factors for progression from IMH to AD include aortic diameter and aortic wall thickness; the liberal use of stent grafting for type B IMH is probably unwarranted.  It remains to be proven whether IMH should be treated any differently from AD.  Until then, except under unusual circumstances, the same treatment approach is likely warranted.

In a retrospective review of 45 cases where patients were placed on VV ECMO, investigators from Seoul performed a multivariate analysis of pre-ECMO risk factors  that might be predictive of  an unsuccessful ECMO wean.  Notably, successful weaning from ECMO was only 46%, and overall survival was only 18%.   Importantly, higher platelet counts at ICU admission and the day prior to initiating ECMO were predictive of successful weaning.  Specifically, patients with a platelet count > 70K had an 11X greater likelihood of a successful wean.  Why?  Is the low platelet count a surrogate for the severity of illness?

Data from the National Lung Screening Trial (NLST) were examined by exploring different size thresholds for classifying CT screening scans as positive.  In the NLST, nearly two-thirds of nodules were 7mm in diameter or less.  Using a threshold of 5mm, the percentage of missed/delayed diagnosis and the likelihood of avoiding false positive findings were 1% and 16%.  Using a threshold of 8mm increased those rates to 11% and 66%.  Increasing size thresholds reduced follow-up CTs and invasive procedures.  Interestingly, differences in thresholds did not affect survival or mortality.