Andexanet Alfa: Considerations and Practical Applications
No abstract available (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 15, 2019 Category: Cardiology Tags: Pathway Source Type: research

Transthyretin Cardiac Amyloidosis as Diagnosed by 99mTc-PYP Scanning in Patients with Acute Heart Failure and Preserved Ejection Fraction
Transthyretin amyloid deposition is present in 17% of autopsies of patients with heart failure and a preserved ejection fraction (HFpEF). 99mTechnetium-pyrophosphate scintigraphy (99mTc-PYP) is sensitive and specific to diagnose cardiac transthyretin amyloid deposition (ATTR). The prevalence of ATTR by 99mTc-PYP was evaluated along with echocardiographic parameters in patients with HFpEF. One-hundred consecutive patients with HFpEF, who had 99mTc-PYP, were retrospectively evaluated. Echocardiographic variables were analyzed to compare patients with positive versus negative ATTR infiltration. Myocardial ATTR was present in ...
Source: Critical Pathways in Cardiology - November 15, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Ankle-Brachial Index in Addition to Stress Testing in Patients Who Presented With Chest Pain and 1-Year Major Cardiovascular Events
Conclusions: Although additional research needs to be conducted, either an abnormal stress test or abnormal ABI suggested an increase of MCE at 1 year with abnormal stress test and ABI demonstrating the highest risk. The addition of ABI to patients undergoing stress testing may enhance risk stratification in patients who present with chest pain. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 15, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Prevalence and Significance of Renal Dysfunction Among Emergency Department Observation Patients With Chest Pain
The objective of this study was to investigate the impact of renal dysfunction on cardiac outcomes in patients with chest pain in an emergency department observation unit (EDOU). Methods: We conducted a 5-year prospective evaluation of patients evaluated in the EDOU for chest pain. We collected baseline information and data from the emergency department visit, EDOU stay, inpatient admission, and the 30-day period after presentation to the emergency department. We calculated glomerular filtration rate (GFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. We stratified patients as having mi...
Source: Critical Pathways in Cardiology - November 15, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Smartwatch for the Detection of Atrial Fibrillation
Atrial fibrillation (AF) is the most common arrhythmia and poses a substantial economic burden due to associated thromboembolic complications. Screening for AF may theoretically be effective, but there is no consensus regarding the optimal screening method because the available tools are either invasive or not cost-effective. Recently, smartwatch industry has received a surge of interest for this purpose by introducing technologies such as photoplethysmography, artificial intelligence, and actual electrodes taking an electrocardiogram to measure and analyze heart rate and rhythm with relatively acceptable accuracy. Combine...
Source: Critical Pathways in Cardiology - November 15, 2019 Category: Cardiology Tags: Review Article Source Type: research

An Updated Healthcare System-Wide Clinical Pathway for Managing Patients With Chest Pain and Acute Coronary Syndromes
Clinical pathways reinforce best practices and help healthcare institutions standardize care delivery. The NewYork-Presbyterian/Columbia University Irving Medical Center has used such a pathway for the management of patients with chest pain and acute coronary syndromes for almost 2 decades. A multidisciplinary panel of stakeholders serially updates the algorithm according to new data and recently published guidelines. Herein, we present the 2019 version of the clinical pathway. We explain the rationale for changes to the algorithm and describe our experience expanding the pathway to all the 8 affiliated institutions within...
Source: Critical Pathways in Cardiology - November 15, 2019 Category: Cardiology Tags: Pathway Source Type: research

Management of Severe Bleeding in Patients Treated With Oral Anticoagulants: Proceedings Monograph From the Emergency Medicine Cardiac Research and Education Group-International Multidisciplinary Severe Bleeding Consensus Panel October 20, 2018
In this Emergency Medicine Cardiac Research and Education Group (EMCREG)-International Proceedings Monograph from the October 20, 2018, EMCREG-International Multidisciplinary Consensus Panel on Management of Severe Bleeding in Patients Treated With Oral Anticoagulants held in Orlando, FL, you will find a detailed discussion regarding the treatment of patients requiring anticoagulation and the reversal of anticoagulation for patients with severe bleeding. For emergency physicians, critical care physicians, hospitalists, cardiologists, internists, surgeons, and family physicians, the current approach and disease indications ...
Source: Critical Pathways in Cardiology - July 26, 2019 Category: Cardiology Tags: Review Articles Source Type: research

Gut Microbiota, Atherosclerosis, and Therapeutic Targets
Several studies have gathered interest in the relationship between gut microbiota and atherosclerosis. Gut microbiota and its metabolites, such as trimethylamine-N-oxide, and gut dysbiosis play an important role in the development of atherosclerosis. Also, inflammation, derived by the intestinal tract, adds another mechanism through which the ecosystem of the human body affects the metabolic diseases and, furthermore, cardiovascular diseases. The scientific world should fixate the understanding of the exact physiologic and pathophysiologic mechanisms for atherogenesis by gut microbiota and through that, new ways for novel ...
Source: Critical Pathways in Cardiology - July 26, 2019 Category: Cardiology Tags: Review Articles Source Type: research

The Association Between Modified Intracoronary Thrombus Grade and Cardiovascular Risk Factors and Initial Laboratory Findings in Patients Undergoing Primary Percutaneous Coronary Intervention
The thrombus burden has been shown to affect the immediate results of primary coronary intervention and the outcome of the patients. The aim of the present study was to determine the cardiovascular risk factors and initial laboratory findings associated with angiographic thrombotic grade based on the new reclassified grading method. A total of 394 consecutive patients presenting with a first ST-elevation myocardial infarction treated by primary coronary intervention were retrospectively evaluated between March 2014 and March 2017. Patients were divided into 2 groups of low thrombus grade (grades 1–3) and high thrombu...
Source: Critical Pathways in Cardiology - July 26, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Comparison of Clinical Outcomes: Bivalirudin With Transfemoral Access Versus Heparin With Transradial Access in Patients With ST segment Elevation Myocardial Infarction
Introduction: The best combination of access site and anticoagulant used during primary percutaneous coronary intervention (PCI) in patients presenting with ST segment elevation myocardial infarction is not known. Methods: We conducted a retrospective cohort study of all patients>18 years of age who underwent primary PCI in 2 large regional ST segment elevation myocardial infarction centers in Massachusetts between 2012 and 2014. The cohort was divided into 3 groups: bival/fem, hep/rad, or off-protocol, based on anticoagulation and access used. We used multiple logistic regression model to compare major cardiovascu...
Source: Critical Pathways in Cardiology - July 26, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Comparing the Modified History, Electrocardiogram, Age, Risk Factors, and Troponin Score and Coronary Artery Disease Consortium Model for Predicting Obstructive Coronary Artery Disease and Cardiovascular Events in Patients With Acute Chest Pain
In conclusion, the CADC model was more effective at predicting obstructive CAD compared to the HEART score. The HEART score and CADC model were equally effective to safely identify low-risk patients by achieving (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 26, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Possible Missed Acute Coronary Syndrome Rate in North Texas: Is There Room to Improve?
Conclusions: The prevalence of missed ACS in the North Texas region at 7 and 30 days after the initial ED visit is low and has not changed over the past several years. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 26, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Impact of an Outpatient Cardiology-managed Urgent Access and Observation Unit on Hospital Admissions
Conclusion: Our first year of data suggests that a cardiology-directed observation unit may serve as a high-value alternative to the ED for appropriately selected patients. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 26, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Genomic Analysis of an Obesity Paradox: A Microarray Study of the Aortas of Morbidly Obese Decedents With Mild and Severe Atherosclerosis
Background: Atherosclerosis of the aorta and coronary arteries is still one of the major causes of death. We recently reported obesity paradox between body mass index and atherosclerosis of the aortas (AA) in morbidly obese decedent patients. The cause of this obesity paradox is unknown. The aim of the present study was to carry out genomic microarray analysis to determine gene expression profiles in the aortas of morbidly obese decedents with either mild or severe atherosclerosis of the aorta. Methods: Microarray studies using Affymetrix GeneChips Clariom D Human array chips were performed on the aortas obtained from...
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Original Article Source Type: research

Improving Door-to-needle Times in the Treatment of Acute Ischemic Stroke Across a Canadian Province: Methodology
Background: Alteplase is a proven medical treatment for acute ischemic stroke; however, the effectiveness of this treatment is highly time dependent. Therefore, it is imperative that hospitals treat acute ischemic stroke patients as quickly as possible. The measure, door-to-needle time, is the time from hospital arrival to when alteplase administration begins. Objective: The goal in the Canadian province of Alberta was to reduce the door-to-needle time to a median of 30 minutes and to increase the percent of patients treated within 60 minutes to 90%. Overview of Methodology: A modified version of Institute for Heal...
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Pathway Source Type: research

Mobile Geolocation Technology to Improve Multidisciplinary Care of Patients With Ventricular Assist Devices: A Feasibility Study
We evaluated the feasibility of a mobile phone–based geolocation technology in patients with ventricular assist devices (VAD). We prospectively enrolled VAD patients with a smartphone for 6 months. A proprietary mobile technology platform (Position Health, Reading, MA) was downloaded onto Apple or Android smartphones. When a patient entered an emergency department, the app was activated and a “ping” with patient location and contact information was sent to our VAD team pager. Fifty-four patients were approached, and 21 were enrolled. The primary reason for nonenrollment was lack of smartphone (46%). The t...
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Adherence to NSTEMI Guidelines in the Emergency Department: Regression to Reality
Conclusions: Prompt identification and early medical treatment of NSTEMI in the ED is lacking. Better computerized medical history assembly, attention to typical and atypical clinical presentation, and the employment of an appropriate cardiologic risk stratification method may unblind the treating teams at the point of care and improve adherence to NSTEMI guidelines. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Diagnostic and Prognostic Role of the Modified Diamond-Forrester Model in Combination With Coronary Calcium Score in Acute Chest Pain Patients
Conclusions: In acute chest pain patients without evidence of ischemia on initial electrocardiogram and cardiac troponin, low PTP by DFM or the combination of intermediate PTP and CCS ≤10 had excellent negative predictive values to rule out 30-day MACE. CCS is not sufficient to exclude obstructive CAD and 30-day MACE in patients with high PTP. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Effect of Age on Procedural Success, Complications, and Clinical Outcome From a Large Angioplasty Registry
Background: Increasing age appears to be a risk factor for adverse outcome in patients undergoing percutaneous coronary intervention (PCI). The goal of this study was to compare procedural success, complications, and 12 months major adverse cardiac events (MACE) based on age using a large angioplasty registry. Methods: This registry included 10,412 patients with at least 12-month follow-up from April 1993 to April 2011. Patients were divided into 3 age groups: group 1 age (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Emergency Department Observation Unit Utilization Among Older Patients With Chest Pain
Background: Although some emergency department observation units (EDOUs) may exclude patients over 65 years old, our EDOU accepts patients up to 79 years old. We assessed the utilization of our EDOU by older patients (those 65–79 years old). Methods: We prospectively enrolled emergency department (ED) patients with chest pain. We gathered baseline data at the time of ED presentation and tracked outcomes related to the ED stay, EDOU, and/or inpatient admission. Our primary outcome included EDOU placement among older patients. Our secondary outcome was the rate of major adverse cardiac events [MACE: myocardial inf...
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Original Articles Source Type: research

One-Hour High Sensitivity Troponin Testing: A Safe and Effective Triage Tool for the Emergency Department
This article reviews the data behind the “rule-in and rule-out algorithm,” which can exclude acute myocardial infarction within 1 hour of presentation through the use of fifth generation high-sensitivity troponin assays. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Review Article Source Type: research

Symptoms Predictive of Acute Myocardial Infarction in the Troponin Era: Analysis From the TRAPID-AMI Study
The TRAPID-AMI (High Sensitivity Cardiac Troponin T assay for rapid Rule-out of Acute Myocardial Infarction) study evaluated a rapid “rule-out” acute myocardial infarction (AMI). We evaluated what symptoms were associated with AMI as part of a substudy of TRAPID-AMI. There were 1282 patients evaluated from 12 centers in Europe, the United States of America, and Australia from 2011 to 2013. Multiple symptom variables were prospectively obtained and evaluated for association with the final diagnosis of AMI. Multivariate logistic regression analysis was done, and odds ratios (OR) were calculated. There were 213/12...
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Original Articles Source Type: research

ACES (Accelerated Chest Pain Evaluation With Stress Imaging) Protocols Eliminate Testing Disparities in Patients With Chest Pain
Conclusions: A care pathway with the expectation for stress imaging eliminates the racial disparity among AA and White participants with chest pain in the acquisition of index-visit cardiovascular testing. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Original Articles Source Type: research

Implementation of an Emergency Department High-Sensitivity Troponin Chest Pain Pathway in the United States
No abstract available (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Pathway Source Type: research

Acceptance of the Chest Pain Unit Certification Process: Current Status in Germany
The nationwide German certification process of specialized chest pain units is unique in Europe. By February 2018, 269 units had already been successfully certified. With that number, more than half of all catheter laboratories across the country offering service on a 24/7 basis for interventional treatment in myocardial infarction take part in that certified chest pain program – with still increasing tendency. Currently, those units provide a mean of one chest pain unit bed per 65,000 inhabitants. Thereby, a high percentage of recertification of about 95% reflects a high acceptance of the concept by the health care ...
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Review Article Source Type: research

Are Prior Aspirin Users With ST-Elevation Myocardial Infarction at Increased Risk of Adverse Events and Worse Angiographic Features?
Despite its clinical benefits, aspirin has been considered one of the predictors of worse outcomes in patients with unstable angina/non–ST-segment-elevation myocardial infarction. Nevertheless, such association has not been demonstrated in patients with ST-elevation myocardial infarction (STEMI). Five hundred eighty-six STEMI patients undergoing primary percutaneous coronary intervention were evaluated including 116 prior aspirin users. Angiographic characteristics and 1-year major adverse cardiac events (MACE) were then compared between the 2 groups. Adjusted analysis showed that the prior aspirin users had a signif...
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Facilitators and Barriers to Reducing Emergency Department Admissions for Chest Pain: A Qualitative Study
Conclusions: In conclusion, most participants have not adopted protocols focused on reducing variation in ED chest pain admissions. Robust systems to ensure follow-up care after ED visits may reduce admission rates by mitigating the perceived risk of discharging ED patients with chest pain. Greater use of observation protocols may promote adoption of clinical guidelines and reduce admission rates. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Implementation of the HEART Pathway: Using the Consolidated Framework for Implementation Research
Conclusions: Successful dissemination of the HEART Pathway will require addressing institution-specific barriers, which includes engaging clinical and financial stakeholders. New SMART-FHIR technologies, compatible with many electronic health record systems, can overcome barriers to health systems with limited information technology resources. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Incorporation of the HEART Score Into a Low-risk Chest Pain Pathway to Safely Decrease Admissions
Chest pain can be a challenging complaint to manage in the emergency department. A missed diagnosis can result in significant morbidity or mortality, whereas avoidable testing and hospitalizations can lead to increased health care costs, contribute to hospital crowding, and increase risks to patients. The HEART score is a validated decision aid to identify patients at low risk for acute coronary syndrome who can be safely discharged without admission or objective cardiac testing. In the largest and one of the longest studies to date (N = 31,060; 30 months), we included the HEART score into a larger, newly developed low-ris...
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Prognostic Utility of the HEART Score in the Observation Unit
In conclusion, our results suggest that patients with a HEART score ≤3 being evaluated for chest pain are at extremely low risk for major adverse cardiac events and may be safely discharged without provocative testing. Positive cardiac testing in this population is more likely to represent a false-positive finding, resulting in unnecessary testing. These findings should be prospectively validated. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Implementation of High-Sensitivity Cardiac Troponin: Challenges From the International Experience
Conclusions: Our survey of hs-cTn implementation at international institutions reveals satisfaction with new assays but reflects important variations in clinical practice. The use of sex-specific vs. combined cutoffs and timing of serial hs-cTn measurements varies across institutions and are subjects that United States centers must define without consensus from international practices. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 13, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Unexpected Cardiac MRI Findings in Patients Presenting to the Emergency Department for Possible Acute Coronary Syndrome
Conclusions: This experience suggests that stress CMR is useful in not only diagnosing symptomatic CAD but also potentially important non-CAD–related disease. These factors may impact their use in ED-based ACS workups. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Serum Uric Acid and Atrial Fibrillation: Meta-analysis
Hyperuricemia has been recently speculated to be associated with the development of atrial fibrillation (AF). A meta-analysis of observational studies was conducted to explore the relationship between serum uric acid (SUA) and AF. We searched the MEDLINE, EMBASE, and CINAHL databases and performed extensive bibliography search to identify studies with mean SUA level for patients with and without AF. Key search terms were “atrial fibrillation” and “uric acid.” Under the random-effects model, the pooled standardized difference in means between patients with and without AF was calculated. A total of 24...
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Articles Source Type: research

The Impact of Formal Training and Certification on the Relationship Between Volume and Outcomes in Percutaneous Coronary Interventions
Conclusions: Our study shows that the angiographic and procedural success rates of PCI, as well as the in-hospital mortality, do not seem to be dependent on the annual volume for formally trained and certified interventional cardiologists. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Articles Source Type: research

A New Feasible Syncope Risk Score Appropriate for Emergency Department: A Prospective Cohort Study
Background: We aimed to compare current syncope risk stratification scores and propose a new more feasible and easy-to-use one. Methods: In this prospective cohort study, we enrolled all patients (≥18 years) with chief complaint of syncope if they were not eligible for admission in terms of high-risk features. San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio, and risk stratification of syncope in the emergency department scores were compared in our population. Results: Overall, 356 patients (mean age: 44.5 years, 46.3% male) were followed for 3 months. Serious adverse events occurr...
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Importance of a Risk Stratification Strategy to Identify High-risk Patients Presenting With Cocaine-associated Acute Coronary Syndrome
Conclusions: Cardiac catheterization in patients presenting with cocaine-associated ACS may be overutilized. A predictive model based on clinical risk factors may help individualize patient care and reduce unnecessary invasive diagnostic interventions. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Role of Hypertension and Other Clinical Variables in Prognostication of Patients Presenting to the Emergency Department With Major Bleeding Events
Background: Clinical variables including hypertension could be linked with major bleeding events and death beyond vitamin K antagonist (warfarin) or direct oral anti-coagulants (DOACs) treatment strategy. Methods: Subgroup analysis of major bleeding (primary endpoint) associated with clinical variables, site of bleeding, ongoing antithrombotics, reversal treatment or blood transfusion, outcomes (secondary endpoints) was performed in patients with bleeding events submitted to hard 5:1 propensity-score matching for hypertension. Results: Enrolled patients were 2,792 (mean age, 65.6 ± 19.9 years) ...
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Continuum of Care for Acute Coronary Syndrome: Optimizing Treatment for ST-Elevation Myocardial Infarction and Non–St-Elevation Acute Coronary Syndrome
No abstract available (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Review Article Source Type: research

Atrial Fibrillation and the Weekend Effect Regarding Cardioversion, Length of Stay, Readmission, and Mortality
Conclusion: In conclusion, a weekend effect was not identified regarding AF in an academic hospital. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 25, 2018 Category: Cardiology Tags: Original Article Source Type: research

Monocyte Chemoattractant Protein-1 as a Predictor of Coronary Atherosclerosis in Patients Receiving Coronary Angiography
Conclusions: MCP-1 is independently associated with CAA among emergency department patients with chest pain. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 17, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Contrast-Enhanced Stress Echocardiography and Myocardial Perfusion Imaging in Patients Hospitalized With Chest Pain: A Randomized Study
Ultrasound contrast-enhanced stress echocardiography improves endocardial visualization, but diagnostic test rates versus stress myocardial perfusion imaging (MPI) have not been studied. A prospective randomized trial was performed between April 2012 and October 2014 at a single-center, safety net hospital. Hospitalized patients referred for noninvasive stress imaging were randomized 1:1 to stress echocardiography or stress MPI. The primary outcome was diagnostic test rate defined as interpretable images and achievement of>85% of age-predicted maximal heart rate (for dobutamine and exercise). Rates were assessed among t...
Source: Critical Pathways in Cardiology - May 17, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Angiographic Characteristics of ST-Elevation Myocardial Infarction Patients With Infarct-related Coronary Artery Ectasia Undergoing Primary Percutaneous Coronary Intervention
Coronary ectasia accounts for 0.3%–4.9% of patients undergoing coronary angiography. We conducted the present study to evaluate the angiographic characteristics of ST-elevation myocardial infarction (STEMI) patients with infarct-related coronary artery ectasia (IRAE) undergoing primary percutaneous coronary intervention. We evaluated 667 STEMI patients who were divided into 2 groups of IRAE (n = 81) and non-IRAE (n = 568). Preprocedural thrombolysis in myocardial infarction (TIMI) flow grade, postprocedural TIMI flow grade, thrombus burden grade, and TIMI frame count were then evaluated. In adjusted analysis, fewer p...
Source: Critical Pathways in Cardiology - May 17, 2018 Category: Cardiology Tags: Original Articles Source Type: research

HEART Failure? Episodes of Missed Major Cardiac Events When Applying the HEART Pathway to an Observation Unit Population
Conclusions: While the HEART Pathway identifies a pooled population at low risk for MACE, risk is not homogenous within this population. Patients with a score of 3 may have higher risk of 42-day MACE that may be unacceptable to some providers, while scores ≤2 saw no events. Caution is advised for those with HEART Pathway score of 3 until more data is available to accurately estimate risk. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 17, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Evaluation of Compliance with a Weight-based Nurse-driven Heparin Nomogram in a Tertiary Academic Medical Center
Background: Recently, our institution adopted a weight-based nurse-driven heparin titration protocol that relies on nurses ordering laboratories, adjusting doses, and initiating boluses. Numerous institutions have implemented similar protocols with reported success. Methods: A single-center retrospective analysis was conducted at the Brigham and Women’s Hospital in Boston, Massachusetts that included all patients who were initiated on the weight-based nurse-driven heparin nomogram during a 30-day period. Nomogram compliance was defined as the rate of correct titrations per nomogram encounter and further separate...
Source: Critical Pathways in Cardiology - May 17, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Angiography-guided Multivessel Percutaneous Coronary Intervention Versus Ischemia-guided Percutaneous Coronary Intervention Versus Medical Therapy in the Management of Significant Disease in Non–Infarct-related Arteries in ST-Elevation Myocardial Infarction Patients With Multivessel Coronary Disease
Conclusions: After primary PCI, complete revascularization in STEMI multivessel disease is associated with lower MACE rates than medical therapy. However, ischemia-testing–guided rather than angiography-guided revascularization was associated with the lowest MACE. This study provides preliminary data and hypotheses for future randomized controlled studies. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 17, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Medication Administration Delays in Non–ST Elevation Myocardial Infarction: Analysis of 1002 Patients Admitted to an Academic Medical Center
In conclusion, 20% of NSTEMI patients did not receive American College of Cardiology/American Heart Association guideline–based medical therapy. Delay in medication administration was significant for women, older individuals, and patients who did not have ischemic findings on the initial ECG. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 17, 2018 Category: Cardiology Tags: Original Articles Source Type: research

The Incidence of Myocardial Injury after Loading Doses of Clopidogrel versus Prasugrel in the Candidates for Percutaneous Coronary Intervention: A Randomized Controlled Trial
Introduction: Prevention of myocardial injury is an essential issue in percutaneous coronary intervention (PCI). We compared the incidence of myocardial injury after loading doses of clopidogrel versus prasugrel in the candidates for PCI. Methods: In this randomized-controlled clinical trial, we enrolled 88 stable angina patients, candidate for PCI. Patients received either prasugrel (60 mg orally) (n = 42) or clopidogrel (600 mg orally) (n = 46). Serum levels of creatine phosphokinase muscle-brain type, cardiac troponin I, and high sensitive C-reactive protein were measured at baseline and 6 and 12 hour...
Source: Critical Pathways in Cardiology - May 17, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Advances in the Treatment of Stable Coronary Artery Disease and Peripheral Artery Disease
No abstract available (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 17, 2018 Category: Cardiology Tags: Review Article Source Type: research

Two-year Follow-up of Patients With Unstable Angina/Non-ST Segment Elevation Myocardial Infarction Undergoing Early Invasive Strategy: Predictors of Normal or Near-Normal Coronary Angiography and Mortality
Background: Predictors of normal or near-normal coronary angiography (NONCAG) in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) and their importance regarding the prognosis are not understood. Accordingly, we determined these predictors as well as mortality risk factors at 2-year follow-up of UA/NSTEMI patients managed by the early invasive strategy. Methods: We prospectively studied consecutive patients with UA/NSTEMI managed with the early invasive strategy at Tehran Heart Center, in 1-year period. Echocardiography was performed before coronary angiography (CAG) for all the patients...
Source: Critical Pathways in Cardiology - February 14, 2018 Category: Cardiology Tags: Original Articles Source Type: research

Complementary Diagnostic Value of Heart Type Fatty Acid-binding Protein in Early Detection of Acute Myocardial Infarction
Background: Heart-type fatty acid-binding protein (H-FABP) is a novel biomarker for myocardial injury. We compared the use of H-FABP with serum levels of cardiac troponin-T (cTnT) and creatine kinase-MB (CK-MB) in the diagnosis of patients suspicious to acute myocardial infarction (AMI). Methods: From October 2013 to December 2014, 182 consecutive patients suspicious to acute coronary syndrome were enrolled in this study, who presented within the past 6 hours from the onset of symptoms. Venous blood samples were drawn at baseline to measure serum biochemistry, high-sensitive cardiac troponin T (hs-cTNT), creatine kina...
Source: Critical Pathways in Cardiology - February 14, 2018 Category: Cardiology Tags: Original Articles Source Type: research