Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Jan 2009
Meta AnalysisMeta-analysis of the relationship between non-high-density lipoprotein cholesterol reduction and coronary heart disease risk.
To determine the relationship between non-high-density lipoprotein cholesterol (HDL-C) lowering and coronary heart disease (CHD) risk reduction for various lipid-modifying therapies. ⋯ Non-HDL-C is an important target of therapy for CHD prevention. Most lipid-modifying drugs used as monotherapy have an approximately 1:1 relationship between percent non-HDL-C lowering and CHD reduction.
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J. Am. Coll. Cardiol. · Jan 2009
Comparative StudyCoronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis).
In this study, we aimed to establish whether age-sex-specific percentiles of coronary artery calcium (CAC) predict cardiovascular outcomes better than the actual (absolute) CAC score. ⋯ Using absolute CAC in standard groups performed better than age-, sex-, and race/ethnicity-specific percentiles in terms of model fit and discrimination. We recommend using cut points based on the absolute CAC amount, and the common CAC cut points of 100 and 400 seem to perform well.
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J. Am. Coll. Cardiol. · Jan 2009
The natural history of asymptomatic ventricular pre-excitation a long-term prospective follow-up study of 184 asymptomatic children.
The aim of this study was to describe the natural history of asymptomatic ventricular pre-excitation in children and to determine predictors of potentially life-threatening arrhythmic events. ⋯ These findings are potentially relevant in terms of early identification of high-risk asymptomatic children with ventricular pre-excitation. Subjects with short APERPs and multiple pathways are at higher risk of developing life-threatening arrhythmic events and are the best candidates for prophylactic ablation.
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J. Am. Coll. Cardiol. · Jan 2009
Comparative StudyThe effect of ventricular assist devices on post-transplant mortality an analysis of the United network for organ sharing thoracic registry.
This study sought to determine the relationship between pre-transplant ventricular assist device (VAD) support and mortality after heart transplantation. ⋯ Extracorporeal VADs are associated with higher mortality within 6 months and again beyond 5 years after transplantation. Intracorporeal VADs are associated with a small increase in mortality in the first 6 months and a clinically significant increase in mortality beyond 5 years. These data do not provide evidence supporting VAD implantation in stable United Network for Organ Sharing status I patients awaiting heart transplantation.
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Historically, cardiac arrest outcomes have been stagnant with few therapies demonstrating clinical benefit. Recent advances in our understanding of cardiac arrest physiology and therapy have led to improved outcomes and renewed interest in defining the "optimal" approach. Cardiocerebral resuscitation (CCR) represents a bundle of specific therapies designed to enhance perfusion during cardiopulmonary arrest by emphasizing chest compressions over ventilations and "priming" the heart with compressions before and after defibrillation attempts. ⋯ Many components of CCR have since been incorporated in the 2005 ILCOR guidelines. Beyond the specific treatment approaches that define CCR, this alternative approach may represent the future of resuscitation science in which each institution and emergency medical services agency will define an optimal approach to treatment and training based on the specific resources available and patient population. This may mandate a paradigm shift away from advanced cardiac life support and basic life support, which emphasize standardization of content and format rather than institution- or agency-specific protocols and training.