European heart journal. Acute cardiovascular care
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Eur Heart J Acute Cardiovasc Care · Aug 2017
Accuracy of a diagnostic strategy combining aortic dissection detection risk score and D-dimer levels in patients with suspected acute aortic syndrome.
The European Society of Cardiology recently proposed a novel diagnostic algorithm combining the aortic dissection detection (ADD) risk score with D-dimer level assessment for detecting acute aortic syndromes (AASs) in patients presenting with chest pain. The diagnostic accuracy of this strategy is yet to be validated. ⋯ A 'high probability' ADD score detected AAS with good specificity. A 'low probability' score combined with negative D-dimer safely and efficiently ruled out AAS with a low failure rate.
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Eur Heart J Acute Cardiovasc Care · Aug 2017
Observational StudyPrognostic implications of fluid balance in ST elevation myocardial infarction complicated by cardiogenic shock.
Positive fluid balance has been associated with adverse outcomes in patients admitted to general intensive care units. We analysed the relationship between a positive fluid balance and its persistence over time in terms of in-hospital outcomes among ST elevation myocardial infarction (STEMI) patients complicated by cardiogenic shock. ⋯ A positive fluid balance was strongly associated with higher 30-day mortality in STEMI complicated by cardiogenic shock.
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Eur Heart J Acute Cardiovasc Care · Aug 2017
Randomized Controlled Trial Multicenter StudyST-segment resolution with bivalirudin versus heparin and routine glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention: The EUROMAX ST-segment resolution substudy.
Myocardial reperfusion after primary percutaneous coronary intervention (PCI) can be assessed by the extent of post-procedural ST-segment resolution. The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial compared pre-hospital bivalirudin and pre-hospital heparin or enoxaparin with or without GPIIb/IIIa inhibitors (GPIs) in primary PCI. This nested substudy was performed in centres routinely using pre-hospital GPI in order to compare the impact of randomized treatments on ST-resolution after primary PCI. ⋯ Pre-hospital treatment with bivalirudin is non-inferior to pre-hospital heparin + GPI with regard to residual ST-segment deviation or ST-segment resolution, reflecting comparable myocardial reperfusion with the two strategies.
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Eur Heart J Acute Cardiovasc Care · Aug 2017
Multicenter Study Clinical TrialExcess mortality and guideline-indicated care following non-ST-elevation myocardial infarction.
Adherence to guideline-indicated care for the treatment of non-ST-elevation myocardial infarction (NSTEMI) is associated with improved outcomes. We investigated the extent and consequences of non-adherence to guideline-indicated care across a national health system. ⋯ The majority of patients hospitalised with NSTEMI missed at least one guideline-indicated intervention for which they were eligible. This was significantly associated with excess mortality. Greater attention to the provision of guideline-indicated care for the management of NSTEMI will reduce premature cardiovascular deaths.
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Eur Heart J Acute Cardiovasc Care · Aug 2017
Diagnostic role and prognostic implications of D-dimer in different classes of acute aortic syndromes.
The role of D-dimer (D-d) as a diagnostic biomarker and its prognostic value in patients with intramural hematoma (IMH) or penetrating aortic ulcer (PAU) are unknown. ⋯ At a cutoff of 0.5 mg/L, D-d was a reliable diagnostic marker for AAD and IMH, but not for PAU. A mean D-d ⩾9 mg/L during the hospitalization was an independent predictor of in-hospital mortality, but did not affect survival at follow-up.