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Buckstein R.,Odette Cancer Center Sunnybrook Health science Center Toronto | Wells R.A.,Odette Cancer Center Sunnybrook Health science Center Toronto | Zhu N.,University of Alberta | Leitch H.A.,University of British Columbia | And 15 more authors.
British Journal of Haematology | Year: 2016

Little is known about the effects of frailty, disability and physical functioning on the clinical outcomes for myelodysplastic syndromes (MDS). We investigated the predictive value of these factors on overall survival (OS) in 445 consecutive patients with MDS and chronic monomyelocytic leukaemia (CMML) enrolled in a multi-centre prospective national registry. Frailty, comorbidity, instrumental activities of daily living, disability, quality of life, fatigue and physical performance measures were evaluated at baseline and were added as covariates to conventional MDS-related factors as predictors of OS in Cox proportional hazards models. The median age was 73 years, and 79% had revised International Prognostic Scoring System (IPSS-R) risk scores of intermediate or lower. Frailty correlated only modestly with comorbidity. OS was significantly shorter for patients with higher frailty and comorbidity scores, any disability, impaired grip strength and timed chair stand tests. By multivariate analysis, the age-adjusted IPSS-R, frailty (Hazard ratio 2·7 (95% confidence interval [CI] 1·7-4·2), P < 0·0001) and Charlson comorbidity score (Hazard ratio 1·8 (95% CI 1·1-2·8), P = 0·01) were independently prognostic of OS. Incorporation of frailty and comorbidity scores improved risk stratification of the IPSS-R by 30% and 5%, respectively. These data demonstrate for the first time, the importance of considering frailty in prognostic models and a potential target for therapeutic intervention in optimizing clinical outcomes in older MDS patients. Trial Registration: ClinicalTrials.gov Identifier: NCT02537990. © 2016 John Wiley & Sons Ltd.

PubMed | Vancouver General Hospital Vancouver
Type: Journal Article | Journal: The Journal of invasive cardiology | Year: 2015

We report a case of five recurrent myocardial infarctions due to repeat spontaneous coronary artery dissection (SCAD) in a woman with underlying fibromuscular dysplasia. Her angiographic SCADs were missed on two occasions. Patients with a history of SCAD are at risk for recurrent dissections. This case also highlights the angiographic variants of SCAD, and the utility of intracoronary imaging in diagnosing suspected SCAD.

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