Clinical cardiology
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Clinical cardiology · Jul 2014
Multicenter StudyFrom door-to-balloon time to contact-to-device time: predictors of achieving target times in patients with ST-elevation myocardial infarction.
The 2013 American College of Cardiology Foundation/American Heart Association ST-segment elevation myocardial infarction (STEMI) guidelines have shifted focus from door-to-balloon (D2B) time to the time from first medical contact to device activation (contact-to-device time [C2D] ). ⋯ In STEMI patients, PHT was associated with significantly reduced C2D and D2B times and was an independent predictor of achieving a target C2D time. As centers adapt to the new guidelines emphasizing C2D time, targeting a shorter D2B time (<50 minutes) is ideal to achieve a C2D time of <90 minutes.
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Clinical cardiology · Jun 2014
Randomized Controlled Trial Multicenter StudyChoice of vein-harvest technique for coronary artery bypass grafting: rationale and design of the REGROUP trial.
The Randomized Endo-vein Graft Prospective (REGROUP) trial (ClinicalTrials.gov NCT01850082) is a randomized, intent-to-treat, 2-arm, parallel-design, multicenter study funded by the Cooperative Studies Program (CSP No. 588) of the US Department of Veterans Affairs. Cardiac surgeons at 16 Veterans Affairs (VA) medical centers with technical expertise in performing both endoscopic vein harvesting (EVH) and open vein harvesting (OVH) were recruited as the REGROUP surgeon participants. Subjects requiring elective or urgent coronary artery bypass grafting using cardiopulmonary bypass with use of ≥1 saphenous vein graft will be screened for enrollment using pre-established inclusion/exclusion criteria. ⋯ Telephone follow-ups will occur at 3-month intervals after surgery until the participating sites are decommissioned after the trial's completion (approximately 4.5 years after the full study startup). To assess long-term outcomes, centralized follow-up of MACE for 2 additional years will be centrally performed using VA and non-VA clinical and administrative databases. The primary MACE outcome will be compared between the 2 arms, EVH and OVH, at the end of the trial duration.
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Clinical cardiology · May 2014
Clinical Trial Observational StudyEffects of renal denervation on ambulatory blood pressure measurements in patients with resistant arterial hypertension.
The sympathetic nervous system is an important factor in hypertension. In patients suffering from resistant hypertension, transfemoral renal sympathetic denervation (RDN) reduces office blood pressure (BP) values. ⋯ Office BP and AMBP levels can be significantly lowered by RDN in patients with resistant hypertension.
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Clinical cardiology · May 2014
Multicenter Study Clinical Trial Observational StudyPatterns of long-term thienopyridine therapy and outcomes in patients with acute coronary syndrome treated with coronary stenting: Observations from the TIMI-38 Coronary Stent Registry.
The optimal duration of dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) is not known. Factors influencing DAPT duration are not well described. ⋯ Patients stabilized for a year after ACS and stenting have low rates of ST relative to overall cardiovascular events. The decision to continue DAPT maybe associated with stent type (DES vs bare-metal stent) and region.
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Clinical cardiology · Apr 2014
Diagnostic performance of copeptin in patients with acute nontraumatic chest pain: BWH-TIMI ED chest pain study.
Arginine-vasopressin (AVP) is an acute marker of physiologic stress. Copeptin is the C-terminal fragment of vasopressin precursor hormone that is more easily measured than AVP. Studies assessing the utility of copeptin in the diagnosis of myocardial infarction (MI) have demonstrated mixed results. ⋯ Copeptin did not improve the diagnostic performance for detecting MI when used alone or in combination with a contemporary sensitive cTnI assay, though our cohort had relatively few early presenters.