Journal of the American College of Cardiology
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J. Am. Coll. Cardiol. · Oct 2012
Comparative StudyOutcome of patients with aortic stenosis, small valve area, and low-flow, low-gradient despite preserved left ventricular ejection fraction.
The aim of this case match study was to compare the outcome of patients with paradoxical low-flow (left ventricular ejection fraction [LVEF] ≥50% but stroke volume index <35 ml/m(2)), low-gradient (mean gradient [MG] <40 mm Hg), a priori severe (aortic valve area [AVA] ≤1.0 cm(2)) aortic stenosis (AS) (PLG-SAS group) with that of patients with a severe AS (AVA ≤1.0 cm(2)) and consistent high-gradient (MG ≥40 mm Hg) (HG-SAS group) and with that of patients with a moderate AS (AVA >1.0 cm(2) and MG <40 mm Hg) (MAS group). ⋯ Prognosis of patients with paradoxical low-flow, low-gradient severe AS was definitely worse than those with high-gradient severe AS or those with moderate AS. The finding of a low gradient cannot exclude the presence of a severe stenosis in a patient with a small AVA and preserved LVEF and should mandatorily prompt further investigation.
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J. Am. Coll. Cardiol. · Oct 2012
Comparative StudyReduction in mortality as a result of direct transport from the field to a receiving center for primary percutaneous coronary intervention.
This study sought to determine whether mortality complicating ST-segment elevation myocardial infarction (STEMI) was impacted by the design of transport systems. ⋯ A STEMI system allowing EMS to transport patients directly to a primary PCI center was associated with a significant reduction in mortality. Our results support the concept of STEMI systems that include pre-hospital referral by EMS.