International journal of cardiology
-
Meta Analysis Comparative Study
Novel oral anticoagulants versus warfarin in non-valvular atrial fibrillation: a meta-analysis of 50,578 patients.
Warfarin, despite its known limitations, is the reference standard treatment for patients with AF and risk factors for stroke. We performed a meta-analysis of phase III trials that compare novel oral anticoagulants (NOACs) with warfarin to determine whether they improve clinical outcomes of patients with non-valvular atrial fibrillation (AF). ⋯ In patients with non-valvular AF, NOACs decrease stroke or systemic embolism, hemorrhagic stroke and mortality, with similar risk of major bleeding compared to warfarin.
-
Multicenter Study Observational Study
Adherence to ACC/AHA performance measures for myocardial infarction in six Middle-Eastern countries: association with in-hospital mortality and clinical characteristics.
This study assesses adherence to performance measures for acute myocardial infarction (AMI) in six Middle-Eastern countries, and its association with in-hospital mortality. Few studies have previously assessed these performance measures in the Middle East. ⋯ Overall adherence was lowest among the highest-risk patients. Lower in-hospital mortality was independently associated with adherence to early performance measures, comprising observational evidence for their effectiveness in a Middle East cohort. These data provide a focus for regional quality improvement initiatives and research.
-
It remains unclear which echocardiographic measure is most suitable for serial measurement in real-world aortic stenosis (AS) follow-up. We determine whether the dimensionless index (DI) between aortic valve and left ventricular outflow tract velocities is measured more consistently using velocity-time-integral (VTI) or peak velocities (V(peak)) in real life. ⋯ Serially-followed variables require minimal noise to maximise detection of genuine change. For AS surveillance, calculating DI--or effective orifice area--from the ratio of V(peak) rather than VTIs would reduce 95% confidence intervals from ± 51% to a still-disappointing ± 25%. Guidelines recommend noisy surveillance measures, causing conscientious echocardiographers to 'peek' at previous values, and impairing clinicians' faith in echocardiographically-observed changes when making clinical decisions. For us in echocardiography to improve our ability to contribute to AS follow-up requires us to first acknowledge and discuss this honestly.
-
Multicenter Study
Utility of 14 novel biomarkers in patients with acute chest pain and undetectable levels of conventional cardiac troponin.
Patients with acute chest pain having serial undetectable cardiac troponin (cTn) levels, as measured with conventional assays, are considered at very low risk. The aim of this multicenter study was to determine the accuracy of multiple biomarkers in these patients. ⋯ Patients with serial undetectable levels of cTnT using the contemporary 4th generation assay are at low but not negligible risk of future cardiac events. Hs-cTnT, MR-proADM and/or GDF-15 might help to further improve risk-stratification in this group.