American heart journal
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American heart journal · Dec 2014
Emergency department visits for heart failure and subsequent hospitalization or observation unit admission.
Treatment of acute heart failure in the emergency department (ED) or observation unit is an alternative to hospitalization. Both ED management and observation unit management have been associated with reduced costs and may be used to avoid penalties related to rehospitalizations. The purpose of this study was to examine trends in ED visits for heart failure and disposition following such visits. ⋯ The number of ED visits for heart failure and the high proportion of ED visits with subsequent inpatient hospitalization have not changed in the last decade. Opportunities may exist to reduce hospitalizations by increasing short-term management of heart failure in the ED or observation unit.
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American heart journal · Dec 2014
Prevalence and clinical outcome of phrenic nerve injury during superior vena cava isolation and circumferential pulmonary vein antrum isolation using radiofrequency energy.
Phrenic nerve injury (PNI) is recognized as an important complication during atrial fibrillation ablation. This study aimed to investigate the incidence and outcome of PNI during superior vena cava isolation (SVCI) and circumferential pulmonary vein isolation (CPVI) using radiofrequency (RF) energy and the factors associated with its occurrence. ⋯ Phrenic nerve injury occurred in 2.1% of the patients. All occurred during SVCI but not during contemporary CPVI. Energy titration and continuous diaphragmatic movement monitoring significantly decreased the incidence during SVCI.
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American heart journal · Dec 2014
Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction.
Borderline electrocardiograms represent a challenge in ST-segment elevation myocardial infarction (STEMI) management and are associated with inappropriate discharges and delays to intervention. ⋯ Subtle STEMI is frequent in clinical practice and is usually associated with acute total coronary occlusion. Therefore, it should be diagnosed and treated in the same expeditiously manner as marked STEMI.
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American heart journal · Dec 2014
Randomized Controlled Trial Multicenter StudyDesign and rationale for the Minimizing Adverse haemorrhagic events by TRansradial access site and systemic Implementation of angioX program.
Transradial intervention (TRI) and bivalirudin infusion compared with transfemoral coronary intervention or unfractionated heparin plus glycoprotein IIb/IIIa inhibitors decrease bleeding complications in patients with acute coronary syndromes (ACS). Although bleeding is thought to be associated with worse outcomes, it remains unclear whether TRI and bivalirudin both independently lower ischemic or combined ischemic and bleeding complications in ACS patients undergoing contemporary invasive management. ⋯ The MATRIX program aims at conclusively ascertaining the role of TRI and bivalirudin infusion in the whole spectrum of ACS patients undergoing contemporary invasive management.
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American heart journal · Nov 2014
Randomized Controlled Trial Multicenter StudyEffect of alirocumab, a monoclonal antibody to PCSK9, on long-term cardiovascular outcomes following acute coronary syndromes: rationale and design of the ODYSSEY outcomes trial.
Following acute coronary syndrome (ACS), the risk for future cardiovascular events is high and is related to levels of low-density lipoprotein cholesterol (LDL-C) even within the setting of intensive statin treatment. Proprotein convertase subtilisin/kexin type 9 (PCSK9) regulates LDL receptor expression and circulating levels of LDL-C. Antibodies to PCSK9 can produce substantial and sustained reductions of LDL-C. The ODYSSEY Outcomes trial tests the hypothesis that treatment with alirocumab, a fully human monoclonal antibody to PCSK9, improves cardiovascular outcomes after ACS. ⋯ ODYSSEY Outcomes will determine whether the addition of the PCSK9 antibody alirocumab to intensive statin therapy reduces cardiovascular morbidity and mortality after ACS.