International journal of cardiology
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A review of cardiac point-of-care (POC) tests used to detect or exclude acute myocardial infarction (AMI) with a focus on test performance within 6 hours after the start of symptoms. ⋯ The ideal POC test for the diagnosis of AMI within 6 hours after the onset of symptoms does not yet exist. Evaluated POC tests were in general of poor methodological quality and reported too many false negatives to be considered as save for the assessment of patients suspected of AMI. A POC test of high-sensitive troponin could possibly fill the gap in the early hours after symptom onset, especially in those with non-definitive electrocardiography.
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Randomized Controlled Trial Comparative Study
Is home warfarin self-management effective? Results of the randomised Self-Management of Anticoagulation Research Trial.
The Warfarin Self-Management Anticoagulation Research Trial (Warfarin SMART) was designed to determine whether patients self-managing warfarin (PSM) using the CoaguChek device and a dosing algorithm developed for the trial could keep the INR (International Normalised Ratio) test in target range at least as often as patients managed by usual care by the family doctor or hospital clinic. ⋯ Patient self-management performed at least as well as usual care in maintaining the INR within the target range, without any safety concerns. This treatment modality for the long-term use of warfarin has the potential to change current local and international practice.
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Randomized Controlled Trial
Cardiac computed tomography guided treatment strategy in patients with recent acute-onset chest pain: results from the randomised, controlled trial: CArdiac cT in the treatment of acute CHest pain (CATCH).
In patients admitted on suspicion of acute coronary syndrome, with normal electrocardiogram and troponines, we evaluated the clinical impact of a Coronary CT angiography (CCTA)-strategy on referral rate for invasive coronary angiography (ICA), detection of significant coronary stenoses (positive predictive value [PPV]) and subsequent revascularisations, as compared to a function-based strategy (standard care). Secondarily we assessed intermediate term clinical events. ⋯ In patients with recent acute-onset chest pain, a CCTA-guided diagnostic strategy improves PPV for the detection of significant coronary stenoses, and increases the frequency of revascularisations, when compared to a conventional functional approach.
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Cardiac computed tomography angiography (CCTA) provides the simultaneous evaluation of the aortic valve, myocardium, and coronary arteries. In particular, aortic valve calcium score (AVCS) can be accurately measured on the same scanning sequence used to measure coronary artery calcification, with no additional cost or radiation exposure. We sought to evaluate the prognostic value of CCTA measures, including AVCS, in asymptomatic aortic stenosis (AS). ⋯ In patients with asymptomatic AS, CCTA measures of valve area, coronary stenosis, and calcification severity provide independent and incremental prognostic value after accounting for the echocardiographic severity of stenosis.
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Acute kidney injury (AKI) is associated with death, end-stage renal disease, and heart failure in patients with coronary heart disease. This study investigated the association between AKI and long-term risk of stroke. ⋯ The long-term risk of stroke is weakly associated with AKI after primary isolated CABG, but this association is attenuated and not significant when considering death as a competing risk.