Contrast-Induced Nephropathy in STEMI Patients With and Without Chronic Kidney Disease
Introduction:
Contrast-induced nephropathy (CIN) following percutaneous coronary intervention (PCI) is associated with adverse outcomes; however, there are scarce data comparing clinical outcomes of post-PCI CIN in ST elevation myocardial infarction (STEMI) patients with and without chronic kidney disease (CKD). We sought to assess the incidence, clinical predictors, and short-term and long-term clinical outcomes of post-PCI CIN in STEMI patients with and without CKD.
Methods:
We performed a retrospective observational cohort study involving 554 patients who underwent PCI for STEMI from February 2010 to November 2013....
Source: Critical Pathways in Cardiology - February 14, 2018 Category: Cardiology Tags: Original Articles Source Type: research
ECG-to-Decision Time Impact on 30-Day Mortality and Reperfusion Times for STEMI Care
The objective of this study is to evaluate E2Decide time on mortality and delayed reperfusion.
Methods:
This was a retrospective study of STEMI activations treated with primary PCI at 2 PCI-capable hospitals located in Duluth, Minnesota, and Fargo, North Dakota, originating in 3 different settings: (1) primary PCI-capable hospital emergency departments, (2) non-PCI facilities, and (3) in the field by emergency medical services. Analysis of variance, generalized linear modeling, and logistic regression models were used in this study.
Results:
There were 289 (96 females) STEMI patients included in our analyses. Non sig...
Source: Critical Pathways in Cardiology - February 14, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Clinical Outcomes of Transferred Versus Onsite Primary Percutaneous Coronary Intervention for Patients With STEMI: Time to Look Beyond Door to Balloon Time
Conclusions:
This study confirms that well-established and integrated regional STEMI programs provide equivalent care to transferred patients and onsite patients. Parameters beyond door to balloon times should be investigated for their contributions to improve patient outcomes. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - February 14, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Experiences of a One-hour Algorithm in Chest Pain Patients With a Nonelevated Troponin T at Presentation
Background:
We aimed to evaluate the use of a 1-hour measurement of high-sensitivity cardiac troponin T (hs-cTnT) in an emergency department (ED) population of chest pain patients with a nonelevated baseline hs-cTnT and to examine the prevalence of early dynamic changes in hs-cTnT and the association with admission rate, diagnosis, and outcome.
Methods:
All patients with a chief complaint of chest pain presenting to the ED of Karolinska University Hospital, Solna, Sweden, from December 2014 to September 2015 who had a baseline hs-cTnT of ≤14 ng/L and a second value obtained within>30 to ≤90 minutes were followed...
Source: Critical Pathways in Cardiology - February 14, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Implementation of an Early Discharge Protocol and Chest Pain Clinic for Low-Risk Chest Pain in the Emergency Department
Background:
Most of the patients presenting to emergency department with chest pain are at low risk of adverse events. Identifying high-risk patients can be challenging and resource intensive.
Methods:
We created a protocol to assist early discharge of low-risk adults with chest pain from emergency department. Also a chest pain clinic (CPC) was started for cardiology follow-up within 72 hours. In a retrospective cohort study, primary outcome of major adverse cardiac events (MACEs) of death, myocardial infarction, or revascularization was compared between CPC patients and those hospitalized for observation. In addition...
Source: Critical Pathways in Cardiology - February 14, 2018 Category: Cardiology Tags: Original Articles Source Type: research
Community Outreach in Terms of Early Heart Attack Care as a New Way of Thinking in Chest Pain Center/Unit Care Giving—Commentary on the German Chest Pain Unit Network
No abstract available (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - December 1, 2017 Category: Cardiology Tags: Commentary Source Type: research
Impact of Sex on Long-term Clinical Outcomes After Percutaneous Coronary Intervention
Conclusions:
During>6 years of follow-up, no significant difference was observed in major clinical outcomes between 2 sexes. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - December 1, 2017 Category: Cardiology Tags: Original Article Source Type: research
Potassium Chloride Sustained Release Dosing Pathway in an Academic Medical Center
Potassium supplementation can be administered intravenously or orally with either immediate release or sustained release formulations. Sustained release potassium chloride allows for delayed absorption and peak effects. In the inpatient setting, it is important to monitor and prevent both hypokalemia and hyperkalemia. Our tertiary-care academic hospital created a clinical pathway for sustained release potassium chloride supplementation in the inpatient population. Our clinical pathway for sustained release potassium chloride creates dosing restrictions designed to prevent hyperkalemia, while allowing exceptions for patient...
Source: Critical Pathways in Cardiology - December 1, 2017 Category: Cardiology Tags: Pathway Source Type: research
Patient Ethnicity Predicts Poor Health Access and Gaps in Perception of Personal Cardiovascular Risk Factors
Conclusions:
There are major gaps between awareness and personalization of risk in major modifiable coronary artery disease risk factors in different ethnic groups. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - December 1, 2017 Category: Cardiology Tags: Original Articles Source Type: research
Troponin Limit of Detection Plus Cardiac Risk Stratification Scores to Rule Out Acute Myocardial Infarction and 30-Day Major Adverse Cardiac Events in ED Patients
When screening for acute myocardial infarction (AMI), troponin levels below the 99th percentile, including those below the limit of detection (LOD), are considered normal. We hypothesized that a low-risk HEART score (0–3) or ACS Pretest Probability Assessment (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - December 1, 2017 Category: Cardiology Tags: Original Articles Source Type: research
Efficacy of Implementation of a Chest Pain Center at a Community Hospital
Introduction:
Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - December 1, 2017 Category: Cardiology Tags: Original Articles Source Type: research
Safety of a 1-hour Rule-out High-sensitive Troponin T Protocol in Patients With Chest Pain at the Emergency Department
Conclusion:
No AMIs or deaths occurred after introducing the 1-hour hs-cTnT protocol to rule-out ACS in chest pain patients, but other MACE such as unstable angina occurred. Our results suggest the protocol is safe to implement in the ED in The Netherlands. (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - December 1, 2017 Category: Cardiology Tags: Original Articles Source Type: research
The HEART Pathway and Hospital Cost Savings
Chest pain is a common complaint in emergency departments. Several guidelines and tools exist to help the clinician determine need for hospitalization. For low-risk patients, clinical judgment can underestimate a patient’s risk of major adverse cardiac event. Implementation of an advanced diagnostic protocol with the HEART Pathway can reduce hospital cost. For our academic institution, we saw an approximate $1 million in total savings during the initial implementation year along with increased outpatient visits. In addition, an increase in outpatient visits confirmed previous estimates that implementation of the HEART Pa...
Source: Critical Pathways in Cardiology - December 1, 2017 Category: Cardiology Tags: Pathways Source Type: research
Pathway for the Management of Hyperglycemia in the Cardiac Care Unit
Inpatient hyperglycemia has been associated with increased morbidity and mortality in critically ill patients. Optimal control of blood glucose (BG) levels using insulin infusion protocols has been shown to improve clinical outcomes. Protocols have been developed to prescribe a safe and effective rate of insulin infusion for optimal control of BG levels; however, a major obstacle in their implementation is their complexity. We have revised and updated our previously published pathway for the management of hyperglycemia, which introduces the “wheel” concept for insulin dosing. The “wheel” serves as a treatment guide...
Source: Critical Pathways in Cardiology - December 1, 2017 Category: Cardiology Tags: Pathways Source Type: research
Community Outreach in Terms of Early Heart Attack Care as a New Way of Thinking in Chest Pain Center/Unit Care Giving—Commentary on the German Chest Pain Unit Network
No abstract available (Source: Critical Pathways in Cardiology)
Source: Critical Pathways in Cardiology - November 14, 2017 Category: Cardiology Tags: Commentary Source Type: research
