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Latest & greatest articles for myocardial infarction
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Can a Negative High-Sensitivity Troponin Result Rapidly Rule Out Acute MyocardialInfarction? TAKE-HOME MESSAGE A single, undetectable, high-sensitivity, cardiac troponin T (hs-cTnT) test in combination with a nonischemic ECG result may effectively rule out acute myocardialinfarction in emergency department (ED) patients presenting greater than 3 hours after symptom onset. Can a Negative High-Sensitivity Troponin Result Rapidly Rule Out Acute MyocardialInfarction? EBEM Commentators Nathan M (...) . Overall acute myocardial infarc- tion prevalence was 15.4%. Of the total included patient population, 30.6% were classi?ed as being at low risk for acute myocardialinfarction by a single negative hs-cTnT result and a nonischemic ECG result. Of these patients, 14 (0.5%) received a diagnosis of acute myocardialinfarction. In 7 of these cases, the time between symptom onset and blood sam- pling was less than 3 hours. The pooled performance estimates for Performanceofhs
In Patients With ST-Segment Elevation MyocardialInfarction, Which Fibrinolytic Agent Is the Safest and Most Effective? TAKE-HOME MESSAGE In patients with ST-segment elevation myocardialinfarction (STEMI), when percutaneous coronary intervention is not an option, reperfusion therapy with the ?brinolytic agents tenecteplase, reteplase, or accelerated alteplase (90 minutes of infusion) plus parenteral anticoagulation has better overall safety and ef?cacy than other regimens. In Patients With ST (...) -Segment Elevation MyocardialInfarction, Which Fibrinolytic Agent Is the Safest and Most Effective? EBEM Commentators Ashis Shrestha, MD Department of General Practice and Emergency Medicine Patan Academy of Health Sciences Kathmandu, Nepal Darlene R. House, MD, MS Department of General Practice and Emergency Medicine Patan Academy of Health Sciences Kathmandu, Nepal Department of Emergency Medicine Indiana University School of Medicine Indianapolis, IN Julie L. Welch, MD Department of Emergency
In Patients With Acute MyocardialInfarction and No Hypoxemia, Does Oxygen Therapy Improve Outcomes Compared With No Supplemental Oxygen? TAKE-HOME MESSAGE Oxygen therapy does notreduce therisk of all-cause mortality,recurrent ischemia or myocardialinfarction, heart failure, or arrhythmias compared with no supplemental oxygen therapy for patients with acute myocardialinfarction and normal oxygen saturation. InPatientsWithAcuteMyocardialInfarctionandNo Hypoxemia, Does Oxygen Therapy Improve (...) , and the most common comorbidities were hypertension, hyperlipid- emia, diabetes, and smoking. Overall, there was no association between oxygen supplementa- tion with any bene?tinpatients with acute myocardialinfarction (Table). Six studies reported all-cause mortality, 6 reported recurrent ischemia or myocardialinfarction, 3 reported heart fail- ure, and 5 reported arrhythmia. Studies varied in quality, with no studies powered to detect a difference in clinically signi?- cant adverse cardiac events. De
Six months versus 12 months dual antiplatelet therapy after drug-eluting stent implantation in ST-elevation myocardialinfarction (DAPT-STEMI): randomised, multicentre, non-inferiority trial. To show that limiting dual antiplatelet therapy (DAPT) to six months in patients with event-free ST-elevation myocardialinfarction (STEMI) results in a non-inferior clinical outcome versus DAPT for 12 months.Prospective, randomised, multicentre, non-inferiority trial.Patients with STEMI treated (...) for an additional six months. All patients that were randomised were then followed for another 18 months (ie, 24 months after the primary PCI).The primary endpoint was a composite of all cause mortality, any myocardialinfarction, any revascularisation, stroke, and thrombolysis in myocardialinfarction major bleeding at 18 months after randomisation.A total of 1100 patients were enrolled in the trial between 19 December 2011 and 30 June 2015. 870 were randomised: 432 to SAPT versus 438 to DAPT. The primary
Combining High Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute MyocardialInfarction Combining 2 signals of cardiomyocyte injury, cardiac troponin I (cTnI) and T (cTnT), might overcome some individual pathophysiological and analytical limitations and thereby increase diagnostic accuracy for acute myocardialinfarction with a single blood draw. We aimed to evaluate the diagnostic performance of combinations of high-sensitivity (hs) cTnI and hs-cTnT (...) for the early diagnosis of acute myocardial infarction.The diagnostic performance of combining hs-cTnI (Architect, Abbott) and hs-cTnT (Elecsys, Roche) concentrations (sum, product, ratio, and a combination algorithm) obtained at the time of presentation was evaluated in a large multicenter diagnostic study of patients with suspected acute myocardialinfarction. The optimal rule-out and rule-in thresholds were externally validated in a second large multicenter diagnostic study. The proportion of patients
Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardialinfarction We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients.We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardialinfarction in three large diagnostic studies. Final diagnoses were
Wearable Cardioverter-Defibrillator after MyocardialInfarction. Despite the high rate of sudden death after myocardialinfarction among patients with a low ejection fraction, implantable cardioverter-defibrillators are contraindicated until 40 to 90 days after myocardialinfarction. Whether a wearable cardioverter-defibrillator would reduce the incidence of sudden death during this high-risk period is unclear.We randomly assigned (in a 2:1 ratio) patients with acute myocardialinfarction (...) ), and nonarrhythmic death in 1.4% and 2.2%, respectively (relative risk, 0.63; 95% CI, 0.33 to 1.19; uncorrected P=0.15). Of the 48 participants in the device group who died, 12 were wearing the device at the time of death. A total of 20 participants in the device group (1.3%) received an appropriate shock, and 9 (0.6%) received an inappropriate shock.Among patients with a recent myocardialinfarction and an ejection fraction of 35% or less, the wearable cardioverter-defibrillator did not lead to a significantly
ST-elevation myocardialinfarction ST-elevation myocardialinfarction - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search ST-elevation myocardialinfarction Last reviewed: February 2019 Last updated: September 2018 Summary Presents with central chest pain that is classically heavy in nature, like a sensation of pressure or squeezing. Examination is variable, and findings range from normal to a critically unwell patient (...) in cardiogenic shock. ST-elevation myocardialinfarction (STEMI) is suspected when a patient presents with persistent ST-segment elevation in 2 or more anatomically contiguous ECG leads in the context of a consistent clinical history. Creatine kinase-MB and cardiac-specific troponins confirm diagnosis. Treatment should, however, be started immediately in patients with a typical history and ECG changes, without waiting for laboratory results. Immediate and prompt revascularisation can prevent or decrease
Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of MyocardialInfarction The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardialinfarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned.This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study.The authors prospectively enrolled unselected patients in 6 countries
Clinical chemistry score versus high-sensitivity cardiac troponin I and T tests alone to identify patients at low or high risk for myocardialinfarction or death at presentation to the emergency department Testing for high-sensitivity cardiac troponin (hs-cTn) may assist triage and clinical decision-making in patients presenting to the emergency department with symptoms of acute coronary syndrome; however, this could result in the misclassification of risk because of analytical variation (...) or laboratory error. We sought to evaluate a new laboratory-based risk-stratification tool that incorporates tests for hs-cTn, glucose level and estimated glomerular filtration rate to identify patients at risk of myocardialinfarction or death when presenting to the emergency department.We constructed the clinical chemistry score (CCS) (range 0-5 points) and validated it as a predictor of 30-day myocardialinfarction (MI) or death using data from 4 cohort studies involving patients who presented
Chest discomfort in a patient with dengue â€“ is it an acute myocardialinfarction? Cardiovascular symptoms presenting in a patient with dengue fever may post a diagnostic dilemma. We describe a case of dengue myocarditis mimicking an acute myocardialinfarction in a 56-year-old woman.
Supplemental Oxygen Protects Heart Against Acute MyocardialInfarctionMyocardialinfarction (MI), which occurs often due to acute ischemia followed by reflow, is associated with irreversible loss (death) of cardiomyocytes. If left untreated, MI will lead to progressive loss of viable cardiomyocytes, deterioration of cardiac function, and congestive heart failure. While supplemental oxygen therapy has long been in practice to treat acute MI, there has not been a clear scientific basis (...) . Myocardial oxygen tension (pO2), cardiac function and pro-survival/apoptotic signaling molecules were used as markers of treatment outcome. OxCy resulted in a significant reduction of infarct size and improvement of cardiac function. An optimal condition of 30-min OxCy with 95% oxygen + 5% CO2 under normobaric conditions was found to be effective for cardioprotection.
Coronary CT Angiography and 5-Year Risk of MyocardialInfarction. Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown.In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (...) (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardialinfarction at 5 years.The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval
Mangafodipir as a cardioprotective adjunct to reperfusion therapy: a feasibility study in patients with ST-segment elevation myocardialinfarction. The aim of the present study was to examine the feasibility of applying the catalytic antioxidant mangafodipir [MnDPDP, manganese (Mn) dipyridoxyl diphosphate] as a cardioprotective adjunct to primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation (STE) myocardialinfarction (STEMI). Both MnDPDP and a metabolite (Mn (...) , plasma biomarker releases were identical for the two groups. With placebo vs. MnDPDP, mean STE resolutions were 69.8 vs. 81.9% (P = 0.224) at 6 h and 73.1 vs. 84.3% (P = 0.077) at 48 h. Cardiac magnetic resonance revealed mean infarct sizes of 32.5 vs. 26.2% (P = 0.406) and mean left ventricular (LV) ejection fractions of 41.8 vs. 47.7% (P = 0.617) with placebo vs. MnDPDP. More LV thrombi were detected in placebo hearts (5 of 8) than MnDPDP-treated hearts (1 of 10; P = 0.011).Mangafodipir is a safe
Myocardialinfarction Top results for myocardialinfarction - Trip Database or use your Google+ account Turning Research Into Practice ALL of these words: Title only Anywhere in the document ANY of these words: Title only Anywhere in the document This EXACT phrase: Title only Anywhere in the document EXCLUDING words: Title only Anywhere in the document Timeframe: to: Combine searches by placing the search numbers in the top search box and pressing the search button. An example search might look (...) like (#1 or #2) and (#3 or #4) Loading history... Population: Intervention: Comparison: Outcome: Population: Intervention: Latest & greatest articles for myocardialinfarction The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials
Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute MyocardialInfarction Vasopressor agents could have certain specific effects in patients with cardiogenic shock (CS) after myocardialinfarction, which may influence outcome. Although norepinephrine and epinephrine are currently the most commonly used agents, no randomized trial has compared their effects, and intervention data are lacking.The goal of this paper was to compare in a prospective, double-blind, multicenter (...) compared with norepinephrine, including an increase in cardiac double product (p = 0.0002) and lactic acidosis from H2 to H24 (p < 0.0001).In patients with CS secondary to acute myocardialinfarction, the use of epinephrine compared with norepinephrine was associated with similar effects on arterial pressure and cardiac index and a higher incidence of refractory shock. (Study Comparing the Efficacy and Tolerability of Epinephrine and Norepinephrine in Cardiogenic Shock [OptimaCC]; NCT01367743
High-Sensitivity Troponins and Outcomes After MyocardialInfarction It remains unknown how the introduction of high-sensitivity cardiac troponin T (hs-cTnT) has affected the incidence, prognosis, and use of coronary angiographies and revascularizations in patients with myocardialinfarction (MI).The aim of this study was to investigate how the incidence of MI and prognosis after a first MI was affected by the introduction of hs-cTnT.In a cohort study, the authors included all patients
Myocardialinfarction Evidence Maps - Trip Database or use your Google+ account Turning Research Into Practice ALL of these words: Title only Anywhere in the document ANY of these words: Title only Anywhere in the document This EXACT phrase: Title only Anywhere in the document EXCLUDING words: Title only Anywhere in the document Timeframe: to: Combine searches by placing the search numbers in the top search box and pressing the search button. An example search might look like (#1 or #2) and (#3