European heart journal. Acute cardiovascular care
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Eur Heart J Acute Cardiovasc Care · Jun 2014
Observational StudyHigh-sensitivity troponin level pre-catheterization predicts adverse cardiovascular outcomes after primary angioplasty for ST-elevation myocardial infarction.
Cardiac troponins are the preferred biomarkers for diagnosing myocardial infarction (MI). High-sensitivity troponin T (hs-TnT) assays have increased sensitivity and enable more rapid diagnosis of infarction. We assessed the prognostic utility of admission hs-TnT to detect outcomes after primary angioplasty for ST-elevation/new left bundle branch block myocardial infarction (STEMI). ⋯ Admission hs-TnT measured in primary angioplasty is strongly prognostic of MACE at 30 days and 1 year, even following adjustment for potential confounding variables.
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Eur Heart J Acute Cardiovasc Care · Jun 2014
Multicenter Study Observational StudyAdditive diagnostic and prognostic value of bioelectrical impedance vector analysis (BIVA) to brain natriuretic peptide 'grey-zone' in patients with acute heart failure in the emergency department.
Few data are available on diagnostic and prognostic role of quantitative fluid retention evaluated by bioelectrical impedance vector analysis (BIVA) in acute heart failure (AHF) patients at the moment of emergency department presentation. ⋯ While in the overall population BIVA did not increase diagnostic accuracy provided by BNP, in AHF patients a quantitative evaluation of fluid congestion obtained by BIVA at the time of emergency department arrival provides significant additive diagnostic and 30-day prognostic value to BNP, particularly in the BNP 'grey-zone'. This could lead to a better management of these patients with possible improvement in reducing subsequent cardiovascular events.
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Eur Heart J Acute Cardiovasc Care · Jun 2014
Multicenter StudyPrognostic impact of atrial fibrillation in acute coronary syndromes: results from the ARIAM registry.
The prognostic ability of atrial fibrillation (AF) in acute coronary syndromes (ACS) is unclear. Studies regarding patient outcomes with respect to the timing of AF are scarce and conflicting. The present study aimed to determine the frequency, predictors and impact on clinical outcome of AF in patients with ACS. ⋯ These findings suggest that the presence of new-onset AF during ACS is associated with a significant increase in mortality, even after adjusting for confounding variables.
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Eur Heart J Acute Cardiovasc Care · Jun 2014
Comparative StudyTowards a consistent definition of a significant delta troponin with z-scores: a way out of chaos?
We assessed the diagnostic performance of z-scores to define a significant delta cardiac troponin (cTn) in a cohort of patients with well-defined clinical outcomes. ⋯ z-scores allow the use of a single cut-off value at all cTn levels, for both cTnI and cTnT and for sensitive and highly sensitive assays, with comparable diagnostic performances. This strategy of reporting significant changes as z-scores may obviate the need for the empirical development of assay-specific cut-off rules to define significant troponin changes.
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Eur Heart J Acute Cardiovasc Care · Jun 2014
Additional value of B-type natriuretic peptide on discrimination of patients at risk for mortality after a non-ST-segment elevation acute coronary syndrome.
Few studies have addressed the additional value of B-type natriuretic peptide (BNP) on risk stratification in non-ST-elevation acute coronary syndrome (NSTE-ACS). We aimed to evaluate whether BNP levels provide additional improvement on discrimination and reclassification of patients at risk of mortality during admission and follow up after a NSTE-ACS. ⋯ Determination of BNP 24-96 hours after a NSTE-ACS improved discrimination of patients at risk for mortality during admission and follow up.