European heart journal. Acute cardiovascular care
-
Eur Heart J Acute Cardiovasc Care · Sep 2017
EditorialClinical impact of delirium and antipsychotic therapy: 10-Year experience from a referral coronary care unit.
Little is known about safety of antipsychotic therapy for delirium in the coronary care unit (CCU). Our aim was to examine the effect of delirium and antipsychotic therapy among CCU patients. ⋯ In patients admitted to the CCU, delirium was associated with an increase in both in-hospital and one-year mortality. Low doses of haloperidol and quetiapine appeared to be safe, without an increase in risk of sudden cardiac death, in-hospital mortality, or one-year mortality in carefully monitored patients.
-
Eur Heart J Acute Cardiovasc Care · Sep 2017
The impact of delirium on outcomes in acute, non-intubated cardiac patients.
Because of progress in cardiovascular management, many critically ill geriatric patients undergo various procedures and intensive cardiovascular care treatments. Although delirium frequently affects geriatric patients post-procedurally and after intensive cardiovascular care, the impact of delirium on acute cardiac patients has not been well understood. The objective of this study was to investigate the impact of delirium on outcomes in acute, non-intubated cardiac patients. ⋯ Acute delirium is common and predicts mortality in non-intubated cardiac patients. Cardiac critical care providers should be aware of this neurological condition.
-
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.
-
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.
-
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.