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 thos...
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 patie...
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 separated in...
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 hours postproc...
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
Positive Predictive Value of Noninvasive Stress Testing Is Poor in the Real World
This study included all consecutive patients (n = 355) who underwent invasive coronary angiography after a positive NIST within ~1-year duration at our institution. Three hundred twenty-four patients were included in the analysis after exclusion of 31 patients. Sixty percent of patients were female and mean age was 63.2 (SD 12.4). Myocardial perfusion imaging, echocardiogram (treadmill or dobutamine), and treadmill electrocardiogram were the tests of choice in 95% (n = 307), 4% (n = 14), and 1% (n = 3) of patients, respectively. Overall PPV of NIST was 36.4% (118/324). When patients were stratified by age ( (Source: Critic...
Source: Critical Pathways in Cardiology - February 14, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Development of an Outpatient Guideline for Optimal Anticoagulation Bridging in Patients With Durable Mechanical Circulatory Support
Patients with durable mechanical circulatory support are at increased risk of thromboembolic and bleeding complications. Current guidelines recommend that these patients receive chronic anticoagulation with warfarin to maintain a target international normalized ratio (INR) as specified by device manufacturers. Limited data exist regarding management of subtherapeutic INRs in this setting. To standardize clinical practice at our institution, we assembled a multidisciplinary task force including members from various specialties to develop a guideline for managing subtherapeutic INRs that incorporates published data and exper...
Source: Critical Pathways in Cardiology - February 14, 2018 Category: Cardiology Tags: Pathway Source Type: research
