Postgraduate medical journal
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Multicenter Study
Transition from CK-MB to troponin did not improve the 1 year mortality of non-ST elevation acute coronary syndromes.
To examine the hypothesis that transition from creatine kinase MB subunits (CK-MB) to troponin as a more sensitive biomarker of myocardial necrosis reduced the 1 year mortality of non-ST elevation acute coronary syndrome (ACS) patients. ⋯ Transition to troponin as a diagnostic marker of MI led to an increase in the incidence of non-ST elevation MI. This transition was not associated with a decrease in the 1 year non-ST elevation ACS mortality rate.
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Sleep-disordered breathing (SDB) describes a group of disorders characterised by abnormalities in the frequency and/or depth of breathing while asleep. The most common type is the obstructive sleep apnoea/hypopnoea syndrome (OSAHS); it affects 2-4% of the adult population and is an independent risk factor for hypertension. Another type is central sleep apnoea (CSA), which includes Cheyne-Stokes respiration; it is most commonly seen in patients with congestive heart failure and other critical illnesses including cerebrovascular accidents. ⋯ Treatment of OSAHS with continuous positive airway pressure (CPAP) has lowered blood pressure, reduced the frequency and severity of some arrhythmias, and improved markers of endovascular inflammation. CPAP has had a mild positive effect on left ventricular function in chronic heart failure by treating co-existent SDB, but it has not improved mortality, possibly because it does not fully treat associated CSA. Clinicians need to be aware of the increasing associations of SDB, especially OSAHS, with cardiovascular dysfunction, as treatment of co-existent SDB will not only improve sleepiness, quality of life, and driving risk, but there is growing evidence that it may also improve cardiovascular risk itself, even in non-sleepy subjects.