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Critical Pathways in Cardiology

Cole E Ziegler, David M Painter, Joseph B Borawski, Raymond J Kim, Han W Kim, Alexander T Limkakeng
BACKGROUND: Stress cardiac magnetic resonance imaging (CMR) has become increasingly used in patients presenting to the emergency department (ED) with symptoms concerning for acute coronary syndrome (ACS). We hypothesized that CMR detects a number of alternative diagnoses (diagnoses other than ACS that could explain symptoms) and incidental findings in patients presenting to the ED for potential ACS. METHODS: We prospectively enrolled adult patients who presented to an academic ED from 2011 to 2015 for possible ACS and subsequently had an adenosine stress perfusion CMR as part of their diagnostic evaluation...
September 2018: Critical Pathways in Cardiology
Stella Pak, Yan Yatsynovich, Damian Valencia, Tian Chen
Hyperuricemia has been recently speculated to be associated with the development of atrial fibrillation (AF). A meta-analysis of observational studies was conducted to explore the relationship between serum uric acid (SUA) and AF. We searched the MEDLINE, EMBASE, and CINAHL databases and performed extensive bibliography search to identify studies with mean SUA level for patients with and without AF. Key search terms were "atrial fibrillation" and "uric acid." Under the random-effects model, the pooled standardized difference in means between patients with and without AF was calculated...
September 2018: Critical Pathways in Cardiology
Habib A Dakik, Wassef Karowni, Katia El-Sibai, Semaan Kobrossi, Karrar Abdul-Ameer, Hani Tamim
BACKGROUND: Little data are available on the impact of formal training and certification on the relationship between volumes and outcome in percutaneous coronary interventions (PCIs).The objective of this report is to study the relationship between PCI volume and outcome for a formally trained interventional cardiologist who is certified by the American Board on Internal Medicine - Interventional Cardiology subspecialty board. METHODS: The operator witnessed 3 different PCI volumes/yr over a 15-year practice period (2000-2014): <50 PCI/yr (years 2000-2006; n = 179), 50-100 PCI/yr (years 2007-2010; n = 256), and >100 PCI/yr (years 2011-2014; n = 427)...
September 2018: Critical Pathways in Cardiology
Ali Bozorgi, Kaveh Hosseini, Arash Jalali, Masih Tajdini
BACKGROUND: We aimed to compare current syncope risk stratification scores and propose a new more feasible and easy-to-use one. METHODS: In this prospective cohort study, we enrolled all patients (≥18 years) with chief complaint of syncope if they were not eligible for admission in terms of high-risk features. San Francisco Syncope Rule, Osservatorio Epidemiologico sulla Sincope nel Lazio, and risk stratification of syncope in the emergency department scores were compared in our population...
September 2018: Critical Pathways in Cardiology
Samineh Sehatbakhsh, Alexander Kushnir, Stefanie Furlan, Elie Donath, Waqas Ghumman, Robert Chait
OBJECTIVE: Current guidelines recommend treating patients with cocaine-associated chest pain, unstable angina, or myocardial infarction similarly to patients with traditional acute coronary syndrome (ACS). Risk stratifying these patients could potentially reduce unnecessary procedures and improve resource utilization. METHODS: This is a retrospective cross-sectional analysis of 258 patients presenting with cocaine-associated ACS who underwent cardiac catheterization in a community teaching hospital between 2006 and 2015...
September 2018: Critical Pathways in Cardiology
Alberto Conti, Daniele Molesti, Simone Bianchi, Stefania Catarzi, Mariuccia Mazzucchelli, Antonella Covelli, Andrea Tognarelli, Mafalda Ester Perrotta, Alessandro Pampana, Giovanni Orlandi, Iginio Dell'Amico, Alberto Baratta, Giuseppe Arena, Tito Torri
BACKGROUND: Clinical variables including hypertension could be linked with major bleeding events and death beyond vitamin K antagonist (warfarin) or direct oral anti-coagulants (DOACs) treatment strategy. METHODS: Subgroup analysis of major bleeding (primary endpoint) associated with clinical variables, site of bleeding, ongoing antithrombotics, reversal treatment or blood transfusion, outcomes (secondary endpoints) was performed in patients with bleeding events submitted to hard 5:1 propensity-score matching for hypertension...
September 2018: Critical Pathways in Cardiology
W Brian Gibler, Judy M Racadio, Amy L Hirsch, Todd W Roat
No abstract text is available yet for this article.
September 2018: Critical Pathways in Cardiology
Lynn Zaremski, Alon Mazori, Eric Shulman, Faraj Kargoli, Tina Shah, Jay Julius Chudow, Ephraim Leiderman, Luigi Di Biase, John Fisher, Kevin Ferrick, Andrew Krumerman
BACKGROUND: The weekend effect is a phenomenon in which worse outcomes have been found to occur over the weekend. This has been investigated in the context of stroke, ST-elevation myocardial infarction, and pulmonary embolism among others. Atrial fibrillation (AF) is the most common sustained arrhythmia, and admissions for AF have been increasing. However, few studies exist investigating the existence of a weekend effect regarding AF. Previous studies have been limited by a pragmatic but unrealistic definition of the weekend starting at midnight on Friday and ending midnight on Sunday...
September 2018: Critical Pathways in Cardiology
Simon A Mahler, Thomas C Register, Robert F Riley, Ralph B D'Agostino, Jason P Stopyra, Chadwick D Miller
BACKGROUND: Animal studies suggest that monocyte chemoattractant protein-1 (MCP-1) is a promising biomarker for coronary artery atherosclerosis (CAA), but human studies have been inconclusive. OBJECTIVE: To determine potential relationships between plasma MCP-1 and CAA in patients with acute chest pain. METHODS: A secondary analysis of 150 patients enrolled in emergency department chest pain risk stratification clinical investigations was conducted...
June 2018: Critical Pathways in Cardiology
Gerald Salame, Whitney E Juselius, Marisha Burden, Carlin S Long, Tiffany Bendelow, Brenda Beaty, Frederick A Masoudi, Mori J Krantz
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)...
June 2018: Critical Pathways in Cardiology
Babak Geraiely, Mojtaba Salarifar, Mohammad Alidoosti, Seyedeh Hamideh Mortazavi
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...
June 2018: Critical Pathways in Cardiology
Alan Tesson, Rami Abdo, Aparna Kamath, Joanne Sutter, Rachel Cline, Sarah L Hale, Jonathan Bae, Lalit Verma
OBJECTIVE: The HEART Pathway risk prediction tool (HEART score plus serial troponin measures at 0 and 3 hours post-presentation) is used to identify low-risk patients with chest pain who may qualify for safe, early discharge. We calculated the percentage of patients in our observation unit that qualified as low risk using HEART Pathway, as well as their associated outcomes. METHODS: We retrospectively reviewed charts on 966 consecutive patients admitted to our observation unit for chest pain (January 2015 to February 2016); HEART Pathway scores were retrospectively calculated and serial cardiac troponin values logged...
June 2018: Critical Pathways in Cardiology
James W Schurr, Craig A Stevens, Anne Bane, Sarah E Culbreth, Amy Leigh Miller, Jean M Connors, Katelyn W Sylvester
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...
June 2018: Critical Pathways in Cardiology
Dhanuka Perera, Tom Crake, Victor Lee
BACKGROUND: In ST-elevation myocardial infarction (STEMI) patients with multivessel (MV) disease, after primary percutaneous coronary intervention (PCI), emerging evidence suggests that significant disease in non-infarct-related coronary arteries (IRAs) should be routinely stented. Whether this procedure should be guided by angiography alone or ischemia testing is unclear. METHODS: All STEMI patients treated with primary PCI between January 1, 2005, and December 31, 2012, at a tertiary cardiology center were reviewed retrospectively...
June 2018: Critical Pathways in Cardiology
LeAnn N Denlinger, Ellen C Keeley
Our goal was to assess adherence to American College of Cardiology/American Heart Association guideline-based medical therapy in patients admitted with type I non-ST elevation myocardial infarction (NSTEMI) and to determine factors associated with medication administration delay. We performed a retrospective analysis using data from the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry. Baseline patient demographics, 12-lead electrocardiogram (ECG) findings, laboratory values, medications administered and the time they were administered, and in-hospital clinical outcomes were collected...
June 2018: Critical Pathways in Cardiology
Reza Rahmani, Laya Jiriaee, Zahra Jiriaee, Akbar Shafiee, Amir Farhang Zand Parsa
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 postprocedural...
June 2018: Critical Pathways in Cardiology
W Brian Gibler
No abstract text is available yet for this article.
June 2018: Critical Pathways in Cardiology
Yaser Jenab, Ebrahim Kassaian, Hamid Reza Pourhosseini, Mojtaba Salarifar, Arash Jalali, Azita Hajhossein Talasaz
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...
March 2018: Critical Pathways in Cardiology
Maryam Sotoudeh Anvari, Mahsa Karimi, Akbar Shafiee, Mohammadali Boroumand, Ali Bozorgi, Reza Sedaghat, Arash Jalali
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...
March 2018: Critical Pathways in Cardiology
Geetanjali Dang, Muhammad Shahreyar, Ahmet Afşin Oktay, Samian Sulaiman, Husein Husein, Ana Inashvili, Nadia Elhangouche, Preethi Subramanian, Mohammad Waqas Bashir, Aradhna Pathak, Shu B Chan, Shahriar Dadkhah
Abnormal noninvasive stress test (NIST) findings do not always correlate with angiographically significant (luminal obstruction ≥50%) coronary artery disease. Positive predictive value (PPV) of NIST in the real clinical practice is not well known. The goal of this retrospective study was to determine the PPV of NIST and assess the factors affecting PPV in a US community hospital. This study included all consecutive patients (n = 355) who underwent invasive coronary angiography after a positive NIST within ~1-year duration at our institution...
March 2018: Critical Pathways in Cardiology
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