Effect of Vitamins and Dietary Supplements on Cardiovascular Health
Cardiovascular disease marks the leading cause of mortality and morbidity in the United States. Pharmacological therapies have been developed to reduce the burden of cardiovascular diseases in the setting of large-scale randomized controlled trials. In contrast, vitamins and minerals have not undergone an equal level of scrutiny, and the evidence of cardiovascular benefit remains elusive. Multivitamins are the most popular over-the-counter supplements in the United States, despite the lack of clear benefit as a means of primary or secondary cardiovascular prevention. Recent studies indicate a potential role of multivitamin...
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Review Article Source Type: research

Ventricular Arrhythmias in Patients with Spontaneous Coronary Artery Dissection: Findings from the Gulf Spontaneous Coronary Artery Dissection (Gulf SCAD) Registry
Conclusions: In-hospital adverse cardiovascular events were significantly more frequent for patients with SCAD who presented with VA. However, follow-up events were not statistically significant between those with and without VA at presentation. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Original Studies Source Type: research

Community Health Workers Reduce Rehospitalizations and Emergency Department Visits for Low-Socioeconomic Urban Patients With Heart Failure
Background: Low-socioeconomic, urban, minority patients with heart failure (HF) often have unique barriers to care. Community health workers (CHWs) are specially trained laypeople who serve as liaisons between underserved communities and the health system. It is not known whether CHWs improve outcomes in low-socioeconomic, urban, minority patients with HF. Hypothesis: CHWs reduce rehospitalizations, emergency department (ED) visits, and healthcare costs for low-socioeconomic urban patients with HF. Methods: Patients admitted with acute decompensated HF were assigned to receive weekly visits by CHW after discharge. ...
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Original Studies Source Type: research

Bleeding Events in Patients 75 Years of Age and Older Under Long-term Anticoagulant Therapy: A Real-life Study
Objective: To investigate the risk of bleeding events in older patients under oral anticoagulant with a 4-year survey of a catchment area with 197,722 inhabitants of whom 15,267 were on warfarin and 10,397 on direct oral anticoagulants (DOACs). Methods: Patients presented to the Emergency Department with major bleeding were enrolled and stratified according to age ≥75 years and ongoing warfarin or DOACs. Primary endpoint was 1-month death. Results: Out of 1919 major bleeding, those of patients ≥75 years of age were 1127 (59%) versus 792 (41%) (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Original Studies Source Type: research

Continuous Monitoring of Coronary Care Mortality Using the Global Registry for Acute Coronary Events (GRACE) Score
Conclusions: Continuous monitoring of coronary care mortality based on cumulative sum charts and the GRACE score demonstrated the occurrence of series of favorable and unfavorable outcomes on a real-time basis. Additionally, plotting the expected-to-observed probability of death for individual cases was useful to individualize unexpected deaths in low-risk patients. Although overall coronary care performance was adequate according to the GRACE score, we found that there is still some room for improvement, since over half of the deaths occurring in low-risk patients were potentially preventable. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Original Studies Source Type: research

Systematic Review of Clinical Decision Support Systems for Prehospital Acute Coronary Syndrome Identification
Conclusions: Although heterogeneity precluded meta-analysis, this review emphasizes the potential of ACS CDSS in prehospital environments that incorporate patient history in addition to integration of multiple components. The higher sensitivity of certain components, along with higher specificity of computer-aided decision-making, highlights the opportunity for developing an integrated algorithm with computer-aided decision support. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Review Article Source Type: research

Predictors of Aspirin Nonadherence in Adults With Prior Myocardial Infarction
Conclusions: In this observational contemporary study of adults with prior MI, predictors of aspirin nonadherence included female sex, Black race, Hispanic ethnicity, currently employed status, and absence of homeowner status. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Original Study Source Type: research

Coronovirus Disease-2019 (COVID-19) Pandemic and Cardiac Electrophysiology: Guidance Protocol From a UK Tertiary Cardiac Center
Since December 2019, the coronovirus disease-2019 (COVID-19) pandemic has resulted in more than 2,160,000 positive cases and more than 145,000 deaths until April 18, 2020. The pressure to the health services worldwide has been unprecedented. The redeployment of staff and resources to treat more efficiently COVID-19 cases along with the need to reduce disease transmission has affected the field of electrophysiology among many others. Amendments to clinical pathways are obligatory in this perspective to continue to provide the necessary health services to the people who need them, although at the same time, infection control...
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Pathway Source Type: research

Restructuring Electrophysiology During the COVID-19 Pandemic: A Practical Guide From a New York City Hospital Network
The coronavirus disease 2019 crisis is a global pandemic of a novel infectious disease with far-ranging public health implications. With regard to cardiac electrophysiology (EP) services, we discuss the “real-world” challenges and solutions that have been essential for efficient and successful (1) ramping down of standard clinical practice patterns and (2) pivoting of workflow processes to meet the demands of this pandemic. The aims of these recommendations are to outline: (1) essential practical steps to approaching procedures, as well as outpatient and inpatient care of EP patients, with relevant examples, (2...
Source: Critical Pathways in Cardiology - July 30, 2020 Category: Cardiology Tags: Original Study Source Type: research

Long-Term Pattern of Red Cell Distribution Width in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Erratum
No abstract available (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 16, 2020 Category: Cardiology Tags: Erratum Source Type: research

Trends of Acute Kidney Injury Requiring Dialysis Among Hospitalized Patients Undergoing Invasive Electrophysiology Procedures
We examined the temporal trend of AKI-D and outcomes associated with AKI-D. The rate of AKI-D increased significantly in both diagnostic/ablation group (8–21/10,000 hospitalizations from 2006 to 2014, P = 0.02) and implanted device group (19–44/10,000 hospitalizations from 2006 to 2014, P (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 16, 2020 Category: Cardiology Tags: Original Study Source Type: research

Impact of Accessory Pathway Location on Electrophysiologic Characteristics and Ablation Success
Conclusions: The location of accessory pathways has a great impact on conductivity, ablation success, and recurrence rate in WPW syndrome. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 16, 2020 Category: Cardiology Tags: Pathway Source Type: research

Yazd Province of Iran ICD Registry for the Years 2014–2016
Conclusions: In comparison between our registry and NCDR registry, baseline patient characteristics and ICD type were almost the same, but the complication rate was higher. There is still a need to perform a large multicenter registry in our community to improve our knowledge in this Era. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 16, 2020 Category: Cardiology Tags: Original Study Source Type: research

Atrial Fibrillation in Hypertrophic Cardiomyopathy: Evidence-based Review About Mechanism, Complications and Management
Hypertrophic cardiomyopathy (HCM) is 1 of the most frequent genetic cardiovascular diseases affecting 1 out of every 500 individuals in general population. Atrial Fibrillation incidences were 3.8% per 100 patients per year and overall prevalence among HCM patients are 27.09%. Higher risk of death noted in HCM patients with atrial fibrillation. Stroke and other thrombo embolic risks are increased in such patients. Medical management using mainly betablockers or amiodarone produced variable results and high rate of recurrence. Catheter ablation reduced symptom burden and complications despite moderate recurrence. Patients wi...
Source: Critical Pathways in Cardiology - May 16, 2020 Category: Cardiology Tags: Review Article Source Type: research

Actionable Ventricular Tachycardia During In-Hospital ECG Monitoring and Its Impact on Alarm Fatigue
Conclusions: In our sample, (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 16, 2020 Category: Cardiology Tags: Original Studies Source Type: research

Frequency and Influence of Exercise-Induced Artifact in Electrocardiograms During Exercise Treadmill Testing for Detection of Myocardial Ischemia
Conclusions: ECGA at peak exercise are frequent and related to peak heart rate and peak metabolic equivalents of resting total oxygen consumption, suggesting a motion effect. ECGA affected the diagnostic accuracy of ETT examinations, indicating that algorithms to reduce artifact for improved diagnosis of ETT require further investigation. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 16, 2020 Category: Cardiology Tags: Original Studies Source Type: research

Trends and Outcomes of Intravascular Imaging-guided Percutaneous Coronary Intervention in the United States
Introduction: Intravascular imaging-guided percutaneous coronary intervention (PCI) has shown to improve outcomes in randomized controlled trials. However, there are little real-world data about intravascular imaging utilization during PCI and its outcomes in the United States. Methods: We conducted an observational analysis on the use of intravascular imaging (Intravascular Ultrasound or Optical Coherence Tomography)-guided PCI in 2,425,036 patients undergoing PCI between January 2010 and December 2014 from the Nationwide Inpatient Sample database. Utilizing propensity score matching, 83,988 matched pairs were identi...
Source: Critical Pathways in Cardiology - May 16, 2020 Category: Cardiology Tags: Original Studies Source Type: research

Value of Repeated Troponin Measurements to Improve the Safety of the HEART Score for Chest Pain Patients at the Emergency Department
Conclusions: Using a representative troponin measurement changed the value of the HEART score in only 3.5% of patients and had no impact on safety and efficiency of the HEART score. These results suggest there is no need to wait for a representative troponin measurement and should encourage physicians to adhere to the original HEART score guidelines. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 16, 2020 Category: Cardiology Tags: Original Studies Source Type: research

Effect of Elevated Calcium Score on Normal Myocardial Perfusion Study on Clinician Management of Coronary Artery Disease Risk Factors
Elevated coronary artery calcification (CAC) scores are associated with higher cardiovascular (CV) risk even with normal stress myocardial perfusion imaging (MPI). Whether referring providers appropriately manage subclinical CV disease is unclear. We hypothesized that ordering clinicians would intensify medical therapy for CV disease in response to normal MPI and CAC ≥ 300. We conducted a cohort study on patients without known CV disease who underwent MPI and CAC scoring. Medical management of CV disease and clinical outcomes were assessed. Of 299 patients who underwent stress MPI, 62 patients had normal MPI and CAC &ge...
Source: Critical Pathways in Cardiology - May 16, 2020 Category: Cardiology Tags: Original Studies Source Type: research

COVID-19 Pandemic and Acute Myocardial Infarction: Management Protocol From a British Cardiac Centre
No abstract available (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - May 16, 2020 Category: Cardiology Tags: Pathway Source Type: research

Clinical Pathway for Management of Suspected or Positive Novel Coronavirus-19 Patients With ST-Segment Elevation Myocardial Infarction
Novel coronavirus-19 disease (COVID-19) is an escalating, highly infectious global pandemic that is quickly overwhelming healthcare systems. This has implications on standard cardiac care for ST-elevation myocardial infarctions (STEMIs). In the setting of anticipated resource scarcity in the future, we are forced to reconsider fibrinolytic therapy in our management algorithms. We encourage clinicians to maintain a high level of suspicion for STEMI mimics, such as myopericarditis which is a known, not infrequent, complication of COVID-19 disease. Herein, we present a pathway developed by a multidisciplinary panel of stakeho...
Source: Critical Pathways in Cardiology - May 16, 2020 Category: Cardiology Tags: Pathway Source Type: research

Long-term Pattern of Red Cell Distribution Width in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Red cell distribution width (RDW) is an indirect marker of inflammation and an independent predictor of long-term mortality. The aim of this study was to determine RDW values in patients with ST-elevation acute myocardial infarction (STEMI) submitted to primary percutaneous coronary intervention (PCI) and evaluate its association with adverse outcomes. We measured RDW in STEMI patients before undergoing primary PCI and divided into low and high RDW. Patients were followed up to 3 years after their discharge for the occurrence of in-hospital, 30-days, and long-term major adverse cardiovascular events (MACEs) and mortality. ...
Source: Critical Pathways in Cardiology - February 19, 2020 Category: Cardiology Tags: Original Articles Source Type: research

How Left Ventricular Size Affects Severity of Disease and Long-term Prognosis in Patients with Severe Systolic Dysfunction?
Conclusions: Our study showed that NLVS defines a group of systolic HF patients which not only did not have less severe disease than those with enlarged left ventricules (i.e., DCM), also had more HF rehospitalization. These NLVS patients also had steady clinical, laboratory, and echocardiographic profile during follow-up. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 19, 2020 Category: Cardiology Tags: Original Articles Source Type: research

One-Month Clinical Outcomes of ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention at a High-volume Cardiac Tertiary Center: Routine Hours Versus Off-hours
Primary percutaneous coronary intervention (PCI) is the treatment of choice for patients with ST-elevation myocardial infarction (STEMI). We aimed to compare 1-month major adverse cardiac events (MACE) of patients undergoing primary PCI between 2 routine-hour and off-hour working shifts. In this cross-sectional study, 1791 STEMI patients were retrospectively evaluated who underwent primary PCI. The patients were classified into 2 groups of routine and off-hour according to the PCI start time and date [495 patients (27.7%) in routine-hour group; 1296 patients (72.3%) in off-hour group]. Cardiovascular risk factor, angiograp...
Source: Critical Pathways in Cardiology - February 19, 2020 Category: Cardiology Tags: Original Articles Source Type: research

Evaluating Association Between Coronary Calcifications Visualized During Invasive Coronary Angiography With Total Mortality
Conclusions: Race, coronary risk factors, and all cause mortality are not associated with angiographic documented coronary calcification in any location in patients undergoing diagnostic coronary angiography. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 19, 2020 Category: Cardiology Tags: Original Articles Source Type: research

Identification and Management of Intermediate Risk Patients in the Chest Pain Unit
We examined low risk (LR) patients admitted to our chest pain unit (CPU) with negative cardiac injury markers, normal electrocardiogram, and clinical stability. We hypothesized that there is a sub-group of intermediate risk (IR) patients within the larger LR population. Methods: Criteria for IR were the aforementioned 3 indicators of LR and ≥1 of the following: (1) known coronary artery disease (CAD), (2) men ≥45 yo, women ≥55 yo, and (3) ≥3 cardiac risk factors. We compared patient characteristics, use of pre-discharge testing (PDT), and major adverse cardiac events (MACE). Results: IR patients numbered ...
Source: Critical Pathways in Cardiology - February 19, 2020 Category: Cardiology Tags: Original Articles Source Type: research

Patient Perception of the Remote Versus Clinic Visits for Interrogation of Implantable Cardioverter Defibrillators
Implantable Cardioverter Defibrillators (ICDs) are used in the management of sudden cardiac arrest. Compared with clinic visits, remote interrogation of these devices has shown clinical benefit and lower cost. We hypothesize that demographic and socioeconomic factors influence patient satisfaction with remote monitoring and therefore the choice of a pathway for follow-up. Questionnaires were mailed to 85 patients (mean age 63 ± 13.5 years, 73% male), with ICDs implanted for primary prevention of sudden cardiac arrest. Information regarding education, social support, employment, and income was collected...
Source: Critical Pathways in Cardiology - February 19, 2020 Category: Cardiology Tags: Original Articles Source Type: research

Oral Liquid Potassium Chloride Dosing Pathway in a Tertiary Care Veteran Affairs Academic Medical Center
Hypokalemia, defined as a serum potassium (K+) concentration of (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 19, 2020 Category: Cardiology Tags: Pathway Source Type: research

Scientist-led Exercise Testing Is Safe With Diagnostic Interpretation Equivalent to a Cardiologist
Background: The implementation of nonphysician-led exercise stress testing (EST) has increased over the last 30 years, with endorsement by many cardiovascular societies around the world. The comparable safety of nonphysician-led EST to physician-led studies has been demonstrated, with some studies also showing agreement in diagnostic preliminary interpretations. Objective: The study aim was to firstly confirm the safety of nonphysician-led EST in a large cohort and secondly compare the interobserver agreement and diagnostic accuracy of cardiac scientist and junior medical officer (JMO)-led EST reports to cardiology co...
Source: Critical Pathways in Cardiology - February 19, 2020 Category: Cardiology Tags: Original Articles Source Type: research

Diagnostic Accuracy of Perfusional Computed Tomography in Moderate Coronary Stenosis: Comparison With Fractional Flow Reserve
Coronary computed tomography with myocardial perfusion imaging (CCTA-MPI) provides data on coronary anatomy and perfusion and may be useful in the assessment of ischemic coronary artery disease (CAD). Management of angiographically intermediate coronary lesions is challenging, and coronary fractional flow reserve (FFR) evaluation is recommended to assess whether these lesions are functionally significant. Our aim was to evaluate the diagnostic accuracy of CCTA-MPI in patients with stable CAD and at least 1 angiographically intermediate coronary lesion submitted to FFR. In this single-center prospective study, patients with...
Source: Critical Pathways in Cardiology - February 19, 2020 Category: Cardiology Tags: Original Articles Source Type: research

The ACIRA Registry: A Regional Tool to Improve the Healthcare Pathway for Patients Undergoing Percutaneous Coronary Interventions and Coronary Angiographies in the French Aquitaine Region: Study Design and First Results
Conclusions: ACIRA has shown its ability to study the patient IC healthcare pathway, up to 1 year after the procedure. Nominative data enable the linkage between clinical and medico-administrative databases and possible supplementary data collection. The use of existing databases allowed us to limit patients lost to follow-up, prevent the double entry of data, improve data quality, and reduce the operating costs. The prospect of linkage with the French National Health Data System may offer promising opportunities for future medical research projects and for developing collaboration and benchmarking with other IC registri...
Source: Critical Pathways in Cardiology - February 19, 2020 Category: Cardiology Tags: Pathway Source Type: research

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