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 thrombus gr...
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 cardiovascular...
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 technology wa...
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 infarct...
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 213/1282 (17%)...
Source: Critical Pathways in Cardiology - February 13, 2019 Category: Cardiology Tags: Original Articles Source Type: research
