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 371,...
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. To compare cli...
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
